Participant Engagement Specialist
Summary : The Participant Engagement Specialist will provide advanced customer service and engagement in reception and registration that enhance the participant experience and access to health care and other services within Heartland Alliance Health while promoting excellence. The individual in this position will handle complex support services including, but not limited to, scheduling appointments, telephone operations, cash collection, auditing and reporting. Individual accountabilities and work volume will be established through the development of annual Success Objectives, within the framework outlined below.
Essential Duties and Responsibilities:
- Greets, welcomes and engages participants into services at assigned locations, including health centers and outreach locations.
- Registers and assesses participants for program eligibility and screens participants for other social service needs or insurance benefits and entitlements services.
- Explains service offerings, answers questions, and makes appointments for all services, including but not limited to, medical, dental, and behavioral health care.
- Answers incoming and makes outgoing phone calls to schedule and remind participants of appointments while ensuring other calls are routed to appropriate person/program in a timely manner.
- Creates telephone note in electronic health record to alert Providers and/or Nurses of Participant requests for call-backs if not immediately available.
- Assists in telephone and other initiatives to increase participant engagement, improve participant experience and service delivery.
- Educates participants regarding patient responsibilities, services, sliding fee scale, patient rights, grievance policy, confidentiality and release of information.
- Generates and updates Program Participation Form and updates participant information as assigned.
- Maintains thorough understanding of medical coverage, managed care organizations, and third party liabilities, inclusive of Medicaid and Medicare. Verifies and updates third party insurance.
- Maintains a strong familiarity with CPT codes and determines amount needed at co-pay based on service rendered. Accurately assesses, explains, and collects co-pays and issues receipts to participants.
- Generates daily and/or weekly reports of collection data. Maintains accurate daily log of co-pay activity.
- Coordinates patient registration activities with Front Desk, Case Management and Billing Department.
- Possesses strong and effective communication skills and assists in coordination of interpretation services for participants as needed.
- Performs moderate to high volume of data entry. Assists with incoming and outgoing mail, and sorts, distributes and logs mail for participants accordingly.
- Conducts quality assurance activities to insure accuracy of program participant data and troubleshoots patient flow issues.
- Attends meetings and trainings as required.
- This position may require working at offsite locations, evening and Saturday hours.
- Other duties may be assigned.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Education and/or Experience: High School Diploma and three years of related experience or Associates degree and one year of related experience. Customer service experience required. Prior experience in a healthcare related field or social service agency preferred.
- Certificates, Licenses, Registrations: Certificate in medical billing, medical office assistant, or a related field preferred.
- Computer Skills: Demonstrated computer proficiency, including knowledge or electronic medical record, word processing, spreadsheet and database software. Ability to use computers to tabulate and analyze data and electronic technology to receive, organize, prioritize, and transmit information.
- Language Skills: Proficiency in a second language may be required.
- Other Qualifications: Ability to calmly and politely interact with others while addressing questions or concerns. Ability to manage multiple calls and prioritize urgent participant needs per protocol. Comprehension of and appropriate use of medical terminology, new developments in the health care delivery system, application of third party payer guidelines and concepts related to quality assurance measures.. General knowledge of medical record keeping and accounting, medical office practices, patient relations, and medical law, ethics and federal and state health care regulations. .
Competencies: To perform the job successfully, an individual should demonstrate the following competencies.
- Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
- Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things
- Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
- Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
- Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
- Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
- Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.
- Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
- Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
- Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
- Safety and Security - Observes safety and security procedures; Determines appropriate action beyond guidelines; Reports potentially unsafe conditions; Uses equipment and materials properly.
- Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
- Team Player - demonstrates that they are a team player by working across the organization to meet participants’ needs; actively builds positive and productive relationships with colleagues in their program/department and across the organization; works collaboratively with others to meet organizational goals and create a positive work environment;
- Initiative - shows initiative in their work, demonstrating extra effort to assure that deliverables are met, quality standards and measures are achieved; offering suggestions for improvement; can be counted on to be where needed, when needed; willingly adjust to shifting priorities and changes in work.
- Participant/Customer Focused - delivers excellent customer service in assisting participants/customers to meet their needs and goals; builds credibility and trust; ensures that concerns/issues are addressed in a timely and appropriate manner; seeks solutions that exceed the participant’s/customer’s expectations.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk and hear.
- The employee is frequently required to stand; walk; sit; use hands to finger, handle, or feel and reach with hands and arms.
- The employee is occasionally required to stoop, kneel, climb or crawl.
- Specific vision abilities required by this job include close vision and ability to adjust focus.
- The employee must occasionally lift and/or move up to 10 pounds.
- Unrestricted ability to provide physical restraint.The employee must occasionally lift and/or move up to 25 pounds. Unrestricted ability to provide physical restraint.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The noise level in the work environment is usually moderate.
Heartland Alliance Health requires all employees to be fully vaccinated against Covid-19 or to undergo weekly Covid testing until they meet that requirement, subject to any lawfully required accommodation.
Heartland Alliance makes all hiring and employment decisions, and operates all programs, services, and functions without regard to race, receipt of an order of protection, creed, color, age, gender, gender identity, marital or parental status, religion, ancestry, national origin, amnesty, physical or mental disability, protected veterans status, genetic information, sexual orientation, immigrant status, political affiliation or belief, use of FMLA, VESSA, military, and family military rights, ex-offender status (depending on the offense and position to be filled), unfavorable military discharge, membership in an organization whose primary purpose is the protection of civil rights or improvement of living conditions and human relations, height, weight, or HIV infection, in accord with the organization's AIDS Policy Statement of September 1987.I,A3303_837_0