Lead Patient Service Representative

SUMMARY:

The Patient Service Representative I (PSR I) works under the direction of the Health Center Manager (HCM). The PSR I will play a key role in onboarding as well as ongoing training of PSR staff both through demonstration and on-the-floor training and PSR timecard oversight. This role supports patient flow oversight through the health center to ensure compliance with Patient Centered Medical Home (PCMH) standards and exceptional customer service. Additional duties include, but are not limited to performing patient intake, collecting and verifying patient information, handling cash collections, patient copays, and credit card transactions, coordinating phone calls, scheduling patients via the computerized scheduler, and verifying eligibility/insurance information and health care benefits to ensure accurate billing procedures. Other duties include scanning/inputting required patient information into the electronic medical record, assisting with patient referrals and program services, and performing other duties as assigned.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Supports and implements the organizations vision, mission, and values.
2. Provides ongoing training to new and existing PSR staff.
3. Monitors patient flow and addresses bottlenecks.
4. Works closely with HCM to address and resolve patient grievances.
5. Monitors and updates staff time schedules to ensure the appropriate availability of staff for the delivery of effective and efficient patient care services.
6. Monitors and analyzes patient appointment schedules to maximize productivity.
7. Monitors and maintains Dramatic Process Improvement process.
8. Ensures Well Messenger is utilized appropriately by all PSRs.
9. Assists HCM with annual PSR training and quarterly internal chart audits.
10. Works in billing department at least once a month.
11. Coordinates the purchase and delivery of office supplies to ensure the availability of adequate equipment and supplies.
12. Determines priorities and methods of completing daily workload to ensure that all responsibilities are carried out in a timely manner.
13. Performs all job functions in a professional and courteous manner. This includes answering all phone calls and emails timely and providing excellent customer service to internal and external customers.
14. Fosters and promotes a culture of service excellence and accountability.
15. Performs timely and accurate patient registration and patient flow tracking in accordance with health center procedures. Determines and verifies patient program/insurance eligibility requirements. Registers patients by verifying that patients records are up to date and accurate. Makes appropriate changes in the computer system and in the electronic medical record (EMR).
16. Demonstrates the ability to identify the patients account via the date of birth or name search; creates accounts for new patient appointments; and verifies and updates demographic information. Knows and follows eligibility requirements and verification processes for coverage programs. Enters confidential personal health information and financial information into the EMR system accurately. Complies with federal and local laws in ensuring patient privacy. Schedules, confirms, and cancels appointments; coordinates walk-in patients; follows up with providers for canceled/no-show appointments. Utilizes the appointment template to meet or exceed productivity standards.
17. Collects payments and co-pays from patients; obtains authorizations for credit card transactions. Applies payments and adjustments to patient accounts in the computer system accurately and reconciles daily cash reports. Adheres to cash collection policies and procedures.
18. Answers telephone calls timely, courteously, and professionally. Follows telephone decision-making guide correctly. Utilizes the computer system correctly to obtain the requested information, update demographic files and/or make, cancel, and reschedule appointments. Provides appointments and information; documents and forwards calls when appropriate and takes detailed messages when required. Completes and submits departmental requests for information and reports.
19. Complies with organizational policies and procedures.
20. Must be willing and able to work at all locations as needed to meet patient care needs.
21. Must be willing and able to work all business hours including evenings and weekends.

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 ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

EDUCATION/EXPERIENCE:

1. High School Diploma or equivalency required.
2. CEC (Certified Enrollment Counselor) Certification required.
3. Five years of healthcare-related customer service or two years of patient intake/registration required. Working knowledge of insurance verification/eligibility insurance programs (Commercial, Medi-Cal, Medicare, and sliding fee programs) required.
4. PC or word processing experience required. Medical coding experience preferred.
5. Certificate in billing and coding and/or Medical Terminology preferred.
6. Experience with electronic health records and practice management systems required, familiarity with EPIC preferred.
7. OCHIN superuser certificate within 90 days of hire required.
8. Excellent telephone and interpersonal communication skills. Must demonstrate superior professionalism when dealing with clients, staff, and vendors required.
9. Familiarity with Current Procedural Terminology (CPT) and International Classification of Disease (ICD) coding a plus.
10. Bilingual in English/Spanish and/or English/Tagalog and/or English/Armenian and/or English/Korean preferred.

LANGUAGE SKILLS:

Ability to read and interpret documents, such as policies and procedures, benefits information, benefit surveys, board minutes, routine mail, simple contracts, and instruction manuals. Ability to compose routine reports and correspondence. Ability to speak effectively with employees, visitors, and management.

MATHEMATICAL SKILLS:

Ability to calculate figures and amounts such as discounts and percentages, and apply concepts of basic algebra and geometry.

REASONING ABILITY:

Ability to exercise common sense in carrying out instructions furnished in written, oral, or diagram form and in other daily situations that arise. Ability to deal with problems involving several concrete variables in standardized situations. Ability to make decisions and execute timely in order to produce a positive outcome. Ability to work independently, set priorities, and work well under pressure.

OTHER SKILLS AND ABILITIES:

This position requires the following minimum requirements:

1. Knowledge of office equipment including copier, fax machine.
2. Skill in dealing with interpersonal issues and customer relations.
3. Ability to handle multiple priorities at once with minimal supervision.
4. Ability to comprehend and follow written and verbal instructions.
5. Ability to organize and communicate clearly.
6. Ability to maintain the confidentiality of patient and employee information.