Patient Services Representative - GVHP Call Center (Full Time, Day)

Call Center Patient Services Representative

At Northbay Health, the Call Center Patient Services Representative performs general office duties including appointment scheduling, determining and verifying insurance eligibility, and processing of detailed messages to physicians. The Patient Services Representative functions as part of a clerical, clinical, and customer service team in support of primary care practices.

Primary Job Duties

• Registration and Charge Entry
• Gathers, updates and verifies a comprehensive package of registration and insurance/payer information and ensures accurate entry into the practice management system.
• Provides information to patients regarding the selection process for a primary care physician, assists in determining insurance eligibility, co-payments, share of costs and other financial responsibilities for services rendered.
• Verifies and documents eligibility for all payers.
• Reviews benefit plan/s with patient to determine specific allowances and/or restrictions based on services requested.
• Researches and answers inquiries related to claims, eligibility and referrals.
• Ensures the accuracy of demographic and insurance information in accordance with the policies, procedures and service expectations of each department.
• Maintains professional standards by actively participating in committees, inservices and QI activities and standards development.
• Acts as a resource to new and existing staff in personal areas of subject matter expertise.
• Presents a professional demeanor in appearance and attitude.
• Floats to other areas as needed.
• Performs other duties as assigned.

Appointments and Reception

• Obtains complete demographic information for new patients ensuring accurate entry into the practice management system. Confirms/updates demographic information for existing patients.
• Confirms eligibility/PCP assignment status for patients with WHA, Health Net or Solano Partnership insurance prior to scheduling appointment.
• Demonstrates effective listening skills to determine appropriate call routing.
• Schedules appointments on the phone in accordance with approved provider protocols and current scheduling policies, procedures and algorithms.
• Monitors provider schedules to ensure appointments are booked for correct type and correct time allocation.
• Places confirmation or rescheduling calls in accordance with scripted guidelines and current policy and procedures.
• Assists in physician schedule maintenance functions including coordination of physician absences with open appointment times.
• Gathers data and performs provider access audits.

Medical Records

• Adheres to System policies related to confidentiality of medical record information, transcription and copies or distribution of medical record content.
• Handles patient documents appropriately to ensure patient confidentiality.

Qualifications

Education

• High School Graduate or equivalent preferred.
• Some college business or computer course work essential.

Licensure/Certification

• AHA BLS certification required within 90 days of hire.
• Course work in medical terminology preferred.

Experience

• 1-2 years working in a healthcare environment required.
• 6 months of direct NorthBay Call Center training/experience can be substituted for healthcare experience.
• 1-2 years direct experience working in a call center environment preferred.
• Strong experience in insurance verification preferred.
• Strong communication skills and dynamic customer service experience preferred.

Skills

• Strong organizational and written and spoken communication skills essential.
• Demonstrated mastery of practice management systems is required with CPT, ICD9 coding experience beneficial.
• Experience in the following areas preferred: appointment scheduling, registration process, insurance verification, primary care preventive care.
• Demonstrated ability to work independently on a variety of complex tasks, managing competing deadlines.
• Bilingual capability preferred.

Standards of Performance

• Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort

• Attendance is an essential function of the job.
• 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 may participate in the following activities.
• Walking, some bending, stooping, and lifting.
• Position requires extensive use of computer keyboarding throughout the day.