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Patient Access Representative/Patient Navigator

Gila Regional Medical Center
Full-time
On-site
Silver City, New Mexico, United States
Client/Customer Success
Full-time
Description

The Patient Access (PAR) representative is responsible for greeting and registration of patients that enter the Gila Regional Medical Center (GRMC). The PAR is responsible for gathering the correct demographic information, necessary billing information, and distributing the required regulatory information for all patients seeking treatment or testing in all departments. S/he registers patients, verifies insurance, seeks authorizations when needed, and operates the central phone and alarm systems. Also expected to perform a number of clerical duties to assist the other departments in the day to day operations of GRMC. Ability to perform said duties in a responsible and professional manner utilizing individual knowledge and skills as well as the knowledge of hospital and departmental policies and procedures. All duties must be performed in compliance with approved standards of care and practice as defined by GRMC.


The Patient Navigator is responsible for providing non- clinical care coordination, primarily focusing on those patients who need increased cancer care/ support. S/he provides care coordination to patients, assisting them through the healthcare process specifically for oral chemotherapeutic medications, providing resources for assistance with co-pays through foundations and/or pharmaceutical companies. S/he is responsible for coordination, scheduling, and medical record requests for new patient consultations for Cancer Center providers. The Patient Navigator position is accountable for working with and representing the Gila Regional Cancer Center across multiple constituents.  


ESSENTIAL FUNCTIONS:

Patient Access Representative

  • Registers patients in a precise, accurate, timely and courteous manner, maintaining 95% data entry accuracy.
  • Updates patient demographics
  • Verifies eligibility of insurance and obtains prior authorizations when required
  • Processes paperwork, ensuring complete and accurate documentation
  • Collects copayments and deductibles, and offers discounts for SP/GCHP according to hospital policy
  • Answers phones and transfers calls
  • Operates the central alarm system
  • Maintains strict standards of confidentiality as required by HIPAA standards
  • Provides front-line customer services; meets and greets visitors and directs patients through hospital areas
  • Processes orders, such as transfers and discharges, from the floor as directed
  • Communicates with other departments, such as Radiology, regarding pending authorizations, rescheduling, and denials• Participates in staff meeting and in-service programs
  • Participates in department on-call program as assigned
  • Operates the switchboard and intercom to relay incoming, outgoing and interoffice calls and messages.
  • Furnishes information/ phone numbers to callers as requested or makes sufficient inquiries necessary to refer the caller to the appropriate hospital personnel.
  • Additional duties as assigned

Patient Navigator

  • Outreach: Develops and maintains relationships with key caregivers in priority sites, builds patient referral mechanisms and promotes the Care Coordination Services.
  • Proactively follows up with patients discharged from all hospitals, rehab facilities and emergency rooms to ensure patient has an appointment with their provider and reviews and requests all medical records prior to the upcoming appointment.
  • Establishes and maintains relationships/alliances with local service practitioners, enhancing referrals for GRMC patients and utilization of community network programs.
  • Works with patients one-on-one and under the direction of RN Care Coordinator and Oncology services to complete comprehensive service assessments of the barriers to improved quality care that contributes to disparities, identifying information, resources and emotional support needs.
  • Assists with financial services: Grant County Health Plan, Foundations, Co-Pay Assistance programs, and refers to other community resources that can aid with disability determination, insurance applications, etc.
  • Support: Works with patients and practitioners to assure patient/family members understand instructions and follow-up specifically with oral medications. 
  • Facilitates patient access to information, including formal and informal support systems, web-based, and printed information. Implements a follow-up plan for each patient to ensure that services have met their needs.  
  • Works with GRMC caregivers to maintain accurate, confidential records, and/or refers to other community resources that can provide such assistance.
  • Assists with processing oral chemotherapy prescriptions, ensuring that patients receive their oral meds through a specialty pharmacy and maintains record of when the prescriptions expire. Obtains updated prescriptions from providers when necessary.  
  • Assists with obtaining medical records from outside clinics in preparation for patients consult visits with providers.

EDUCATION & TRAINING REQUIREMENTS:


  • Minimum High School Diploma or GED
  •  1 – 2 years college preferred
  • Customer service experience required, with insurance billing preferred
  • Familiar with medical terminology
  • Basic computer skills
  • Familiar with and/or able to use Microsoft Outlook
  • Bilingual in Spanish preferred

 

Note: Job description available upon request**All required documents must be presented at time of hire.**EXTERNAL APPLICANT: Employment is contingent upon successful completion of pre-employment drug and alcohol testing.GRMC is an Equal Opportunity Employer