The great history of Home Health Foundation is now the future of Tufts Medicine Care at Home.

Care at Home is a proud member of Tufts Medicine, a health system that is rethinking how academic and community centers, local and national businesses, and technology and service innovators can all work together. So that clinicians can deliver expert care where it’s needed most. And, so that we can bring wellness back to health care, one person at a time.

Why Join Us?  Benefits you will love, Generous earned time package, Retirement plan with employer match, Tuition reimbursement and More!   

The Patient Access Specialist is responsible for the non-clinical portion of the referral process for patients seeking services from Care at Home.  The Patient Access Specialist follows procedures to complete demographics, verify eligibility, and accept or decline patients for services based on specific criteria which includes with Care at Home service areas, contracted payers vs non-contracted payers, and services Care at Home provides.   The Patient Access Specialist will also be required to obtain documents necessary to accept patient(s) on for services with Care at Home.  

Essential Functions 

• Review documents sent by referral source (via portal, fax or other method) to determine information   received and needed to complete the referral based on department guidelines. 
• Manage faxes that electronically drop into Forcura continuously throughout the day.  Needs to be reviewed within 15 minutes of receipt/time stamp. 
• Prioritizes completion of specified referrals based upon referral department prioritization process (e.g., hospice referrals and using start of care date as a guide). 
• Input referrals in Forcura and HCHB timely and accurately based on department guidelines, which includes productivity and quality requirements. 
• Inputs data into the "Request for Services" form for new phone referrals (in Forcura). 
• Accepts or declines referrals based on service area and the services HHF provides. 
• Determines home care eligibility based on payer, along with the having the knowledge to accept referrals based on payer regulations, contracts and plan types. 
• Follows department process within Forcura to manage non-clinical referral from initiation to completion. 
• Make calls to referral sources for additional documentation or information (e.g., discharge status or paperwork), and update status in Forcura tracking. 
• Sends updated lists four (4) times daily (at 7:30 a.m., 9:00 a.m., 12:00 p.m. and 3:00 p.m.) to Liaisons with same/next day start of care (SOC) referrals. 
• Identifies opportunities to generate potential referrals for agency to provide services to meet patients' needs.   
• Timely and accurately verifies eligibility and benefits for insurances identified through the eligibility process; obtains the effective date of coverage and includes whether services are covered. 
• Has expert knowledge of payers and plan types. 
• Has a clear understanding of patient responsibilities including deductibles, coinsurance, or copayments. 
• Document patient financial responsibility in EMR so patient can be made aware of their patient responsibility. 
• Determines which payer/plan is primary if there is more than one active payer and understands    
• Coordination of Benefits rules. 
• Understands billable services under home health and hospice. 
• Understands hospice nuances around Medicare and Medicare Advantage plans including     
• identifying and recording benefit periods. 
• Ability to run, review, and update patient records via eligibility reports. 

Position Type/Expected Hours of Work & Travel 

This is a full-time position, and days fluctuate from Sunday through Saturday (rotational weekend coverage required). This is a hybrid role that once training is complete will work 1 day in office and 4 days remotely. Hours range from 7:30 a.m. – 6:30 p.m., and are determined based on the needs of the department.  There may be some flexibility with scheduled hours based on the position.  

• Knowledge of insurance authorization/utilization process required. 
• Knowledge of in networks and out-of-network-payers, Medicaid, Medicare, and commercial plans preferred.  
• Coordination of benefits knowledge preferred.  

Care at Home is an equal opportunity employer- M/F/Veteran/Disability.

AAP/EEO Statement

Tufts Medicine Care at Home is an Equal Opportunity Employer and dedicated to the goal of building a diverse and inclusive workplace that reflects the patient population in which we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, protected veteran status, genetic information, or any other characteristic protected by applicable law. Care at Home is especially interested in candidates who, through their service, training and experience, will contribute to the diversity and excellence of our health care community.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.