Patient Access Specialist/Navigator

Summary

Combined responsibilities in patient access operations and certified health insurance navigation. The position oversees daily scheduling functions while delivering exceptional customer service. As a certified Health Insurance Navigator, the individual provides ongoing support for Medicaid, MCHP, and QHP eligibility, enrollment, renewals, and disenrollment, in line with ACA guidelines and MLMC policies. Certification requires passing federal and/or state exams, completing background checks, and adhering to ethical standards, including avoiding conflicts of interest.

Key Responsibilities

Patient Access Specialist:

• Enter patient information into the Practice Management system; verify insurance coverage or sliding fee eligibility, input payer codes, and determine co-pays.
• Confirm and update existing patient demographics and insurance details.
• Verify PCP assignment for Managed Care Plans; complete PCP change forms as needed.
• Ensure accurate billing by entering correct demographic and insurance data.
• Check in patients, collect co-pays and fees, verify income for sliding fee programs, and notify clinical teams via the Electronic Health Record (EHR).
• Answer and route phone calls, take messages, and document in the EHR.
• Schedule and check out patient appointments according to clinic guidelines; manage follow-ups and co-pay collection.
• Maintain and balance individual cash drawer per financial policy.
• Assist patients with billing inquiries and explain financial transactions; coordinate with Billing Specialists as needed.
• Deliver compassionate, patient-centered service with the ability to multitask and communicate empathetically.
• Enter monthly provider schedules, file paperwork, and assist with insurance questions.
• Stay current on insurance policies, medical services, and healthcare regulations through ongoing education.
• Perform miscellaneous tasks including signing for deliveries, attending staff meetings, and other duties as assigned.
  
  

Insurance Navigation

• Conduct outreach and education for uninsured and underinsured individuals within the MLMC service area.
• Assist with health plan selection based on individual needs, including tax implications, premiums, and cost-sharing.
• Facilitate applications, enrollment, renewals, and disenrollments for Medicaid, MCHP, and Qualified Health Plans (QHPs).
• Support eligibility determinations, redeterminations, changes in circumstances, and managed care organization selection.
• Provide ongoing assistance with enrollment-related issues for Medicaid, MCHP, and QHPs. Complete required training and maintain certification as a Navigator through the Maryland Health Benefit Exchange.
• Upholds the Code of Ethics and mission of Mountain Laurel Medical Center in a manner consistent with the core values of patient focused, respect, accountability, teamwork, continuous improvement, and integrity.
  
  

Core Value Statements

Patient Focused

The patient comes first and is central to all decision making.

Respect

Treat all patients and staff the way you expect to be treated.

Accountability

Each employee owns their actions, and expects the same from all others.

Teamwork

It is necessary to work together in a supportive manner to achieve common goals.

Continuous Improvement

Stay committed to the pursuit of excellence, always finding ways to adapt and improve.

Integrity

Always do the right thing.

Qualifications

• Certified Health Insurance Navigator or eligible for certification through the Maryland Health Benefit Exchange, including successful completion of training, background check, and adherence to ethical standards.
• Knowledge of Medicaid, MCHP, and Qualified Health Plan (QHP) eligibility and enrollment processes.
• Strong interpersonal and communication skills with the ability to provide empathetic, patient-centered service.
• Proficiency with Electronic Health Records (EHR), medical scheduling systems, and insurance verification procedures.
• Demonstrated ability to work collaboratively in a team-based environment while multitasking in a fast-paced setting.
• Ability to maintain professionalism and confidentiality when interacting with diverse patient populations.
  
  

Education And Experience

• High school diploma or equivalent required.
• Three (3) years of related experience in a medical office, healthcare access, or customer service setting preferred.
• Prior experience in insurance navigation, patient access, or medical billing highly desirable.
• A combination of education and experience may be considered.
  
  

Computer Literacy

Knowledge of basic computer software and Electronic Health Record (EHR) systems.

Insurance Knowledge

Vast understanding of the different types of insurances and the knowledge and ability to distinguish the differences in coverage, charges and co-pays; essentially becoming an expert. Understanding and ability to interpret a patient's financial record and the impact on the revenue cycle.

Work Record

Consistent attendance, reliability, and teamwork are essential. Must demonstrate professionalism and the ability to work well with diverse individuals in a medical office setting.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals is essential. Ability to write routine reports and correspondence, and the ability to speak effectively to patients, co-workers and the public at large is paramount.

Mathematical Skills

Must have the ability to calculate figures and amounts such as sliding fees, discounts, interest, proportions and percentages along with mathematical accuracy and attention to detail are essential skills for this position.

Reasoning Ability

Must be able to demonstrate the ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Team Work

An essential element is the ability to work and interact effectively and positively with other staff members to build and enhance teamwork in a patient centered team based model of care and in the overall MLMC organization; team engagement is a must to be successful in this position.

Sensitivity To The Needs Of Special Populations

Must be able to demonstrate the ability to understand and respond appropriately, effectively and sensitively to special population groups served by MLMC. Special population groups include those defined by race, ethnicity, language, age, sex, sexual orientation, economic standing, disability, religion, etc.

Understanding Of HealthCare Laws And Regulations

Must have the ability to follow HIPAA guidelines as well as an understanding of policies and procedures regarding medical records put in place by the Federal Government.

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 frequently required to drive, sit, handle papers, type and operate computer equipment; reach with hands and arms; talk, see and hear. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

Work is performed in a typical outpatient medical clinic environment. Some local trips by automobile may be required (i.e., Post Office, hospital office supplies, etc.). Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job