Total Healthcare is in need of Hybrid PAL/PAS

Total Health Care, Inc.

Job Class Specification/Job Description

Title: Hybrid PAL/PAS

Grade:  TBD

FLSA:  (Non-Exempt)

Financial Disclosure: May be required to file

Job Summary

Reporting to the Revenue Cycle and/or their designee, the Patient Advocate Liaison/PAS (Hybrid) are tasked with providing information and support to Total Health Care patients, as well as their relatives and caregivers. These liaisons must be friendly and have interpersonal skills while also remaining communicative at all times, as they are expected to provide information in ways that are easily understood and processed by non-medical professionals. Maintain patient rights by educating patients; responding to patient and patient family complaints; resolving patient issues; reporting unresolved issues. (60%)

Responsible for confirming patient demographic and insurance information to ensure accurate billing for services provided by Total Health Care (THC). To accomplish this, the PAS must enter all necessary information into Total Health Care’s (THC) Electronic Medical Record (EMR) systems for all departments (i.e. dental, medical, mental health or substance abuse). The PAS identifies patients in need of financial assistance and assist them per THC policies and procedures. (40%)

Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC’s executive management, community organizers, the general public, THC’s patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information.

Example of Essential Job Functions for the Patient Advocate Liaison Responsibilities (60%)

  • Offer a warm welcome to the clinic, collect patient information to get them signed in, direct them to the correct department, and finding ways to improve overall patient care experience.
  • Serve as intermediary between health care organization and patients
  • Prepare incident reports as needed
  • Convey questions, complaints, problems, and concerns of patients to proper personnel
  • Document patients’ complaints and grievances
  • Present the organizations patient rights philosophy to patients by visiting with them; introducing them to the services that THC has to offer at all locations; confirming their understanding of who to contact with questions or concerns.
  • Offer suggestions to resolve common complaints; implement modifying practices that cause repeated complaints
  • Alerts the Compliance department and CTO by documenting unresolved complaints and potential legal issues
  • Maintains patient and family confidence by keeping complaint information confidential
  • Improves quality results by studying, evaluating, and re-designing patient complaint processes; implementing changes as approved by management.
  • Serves and protects the organization by adhering to professional standards, THC policies and procedures, federal, state, and local requirements, and HRSA standards.
  • Enhances patient advocacy and the clinic’s reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

Patient Access Specialist Example of Essential Job Functions (40%):

  • Completes insurance verification (EVS) on all patients scheduled to be seen at any THC site or department (Pediatrics, Adult Medicine, OB/GYN, Dental, infectious disease, IBH, CESH/Substance Abuse).
  • Confirms and enters patient’s current insurance status in the Practice Management System (PMS) at the time of check in.
  • Communicates co-pay or payment requirements at time of service.
  • Collects payments, co-payments as well as deductibles at point of service and post receipts
  • Completes daily self-pay log for self-pay patients and obtains appropriate sign-off from Patient Access Supervisor.
  • Reconciles receipts and prepare point of service collections for bank
  • Adheres to company procedures for keeping of cash secure
  • Confirms that THC is listed as the facility providing care for the patient and ensuring that the specific THC Primary Care Provider is entered in the PMS.
  • Confirms authorizations are secured for CESH and Substance Abuse departments for current and upcoming visits.
  • Obtains secondary QMB cards for qualified patients.
  • Completes Medicare Secondary Payer questionnaire for appropriate coordination of benefits.
  • Assists with meeting department goals and department KPIs measures while maintaining
  • Follows up with patient to clarify benefits and correct coordination of benefit issues.
  • Provides financial counseling and providing information about the Maryland Health Connection, including eligibility requirements for applicable federal premium subsidies and cost-sharing assistance.
  • Facilitate enrollment into Medicaid, MCHP, or a Qualified Health Plan.
  • Provides referrals to appropriate agencies including the Attorney General’s Health Education and Advocacy Unit (HEAU) and the Maryland Insurance Administration (MIA), for applicants and enrollees with grievances, complaints, questions or the need for other social services.
  • Scans front and back of patients’ insurance/identification cards so they can be uploaded to the
  • Completes the primary care provider change form if provider information is not valid and submits it via secure fax and obtain fax confirmation receipt on the day of the visit.
  • Assists patients with completion of the Intake/Consent forms and OMS
  • Obtains all necessary signatures and documentation required by the patients’ insurance plan.
  • Determines the appropriate financial class and/or account type and correctly assign primary and secondary insurance billing status when two insurance plans require coordination of
  • Determines eligibility of patients for 30 day/6 month sliding fee scale
  • Monitors 6 month sliding fee patients for appropriateness and to determine insurance eligibility status.
  • Tracks Department of Social Services vouchers and other third party/community payer documentation as well as medical form and submit to Revenue Cycle Manager for billing.
  • Other duties as

Minimum Education, Training and Experience required
2+ years working in an outpatient clinic setting

Experience working in a non-profit or FQHC is strongly preferred

High School diploma or equivalent (post High School education preferred) and/or any combination of education, training and experience providing understanding of the field and the ability to perform the essential functions of the job. Two years hospital or physician practice patient registration, customer service, insurance verification, financial clearance, or billing and ICD-9 medical coding experience in a healthcare environment.

Certification as a Certified Healthcare Access Associate CHAA (NAHAM)

Persuasion, Verbal Communication, Health Promotion and Maintenance, HRSA Regulations, Building Relationships, Resolving Conflict, Coordination, Listening, Compliance, Organization, Integrity, Excellent time management skills, Strong attention to detail required and other duties as assigned.

Required Knowledge, Skills and Abilities
Knowledge of FQHC operations, operating principles, guidelines and bylaws. Excellent leadership, customer service, organizational and presentation skills as well as the ability to effectively communicate THC’s vision, and motivate others to achieve it organizationally, departmentally, and personally/professionally. Ability to communicate effectively (verbally and in writing). Ability to plan and organize work initiatives to successfully accomplish center/organizational goals and objectives. Ability to multi-task, prioritize and delegate as appropriate. Strong analytical, problem solving and interpersonal skills. Ability to identify, develop and implement short/long-term strategic goals and objectives. Ability to develop and maintain customer relationships; influence, build credibility and trust. Ability to think critically as well as apply critical thinking skills. Ability to: ensure and advocate for quality healthcare and services; and, lead and manage a diverse staff.

 Licenses and Certifications

Physical Demands

Must have the use of sensory skills in order to effectively communicate and interact with other employees and the public through the use of the telephone and personal contact as normally defined by the ability to see, read, talk, hear, handle or feel objects and controls.

Ability to effectively use and operate various items of office related equipment, such as, but not limited to: personal computer, calculator, copier, and fax machine.

Ability to lift, carry, push or pull heavy objects in excess of 75lbs as well as squat, walk, climb, bend, crouch, stoop, kneel, stand, grasp, reach, pull and repetitive motions.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Environment

Work is typically performed in an office setting or a variety of environments and conditions including offices, mechanical rooms, confined spaces, and other circumstances that include increased physical risk and exposure to adverse environmental conditions.

 Designation as Essential Personnel


Application Process

To apply, e-mail resume and cover letter to: