Patient Experience Representative

WELLSPACE HEALTH•Rancho Cordova, CA

1d•Onsite

About The Position

The Patient Experience Representative is responsible for all administrative functions to support the Office of Patient Experience in accordance with established policies and procedures. Administrative functions include but are not limited to the documentation, research and resolution of grievances, comments, concerns, website email, “we listen” and social media reviews as presented by patients or their authorized representatives, contracted Health Plans and providers. This individual will have a strong work ethic, excellent relational skills, is self-directed, and enjoys working in a fast-paced environment.

Requirements

High School graduate, some college preferred OR an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job.
Excellent customer service experience including active listening, problem solving, and the ability to remain calm in emotional or stressful situations.
Demonstrated commitment to the provision of services for the underserved and sensitivity working with a variety of people from low-income populations, with diverse educational, lifestyle, ethnic, and cultural origins; disabled, homeless, substance users, HIV (AIDS) infected, and/or physiologically impaired.
Establish and maintain positive, professional relationships.
Ability to perform administrative tasks which includes, but is not limited to communication, technology, organization, planning and problem-solving.
Prioritize, organize and execute tasks in a changing environment.
Ability to maintain detailed records.
Computer (PC) literate in Microsoft Word, Excel, Powerpoint, Outlook email and database software.
Ability to use standard office equipment including phone, fax, copier, computer.
Able to take and follow through with delegated tasks and accountability.
Communicate clearly and concisely, both verbally and in writing and demonstrate a high level of listening skills.
Commitment to HIPAA and ability to abide by standards of professional ethics and maintain confidentiality.
Adherence to infection control procedures, including but not limited to, standard precautions of temperature monitoring, hand washing, symptom self-monitoring, masking and social distancing.
Assist and support the Center/Department/Program to meet standards of High Reliability.

Nice To Haves

Knowledge of state funding sources preferred.
Fluency in additional languages preferred.

Responsibilities

Analyze, research, resolve and respond to complaints, grievances, comment forms, website email, “we listen” and social media reviews from patients, providers, and regulatory agencies with established regulatory and accreditation guidelines.
Prepare summaries and write resolution letters for Health Plans, which include summarizing patient’s grievances and steps taken to resolve complaints in clear and grammatically correct language.
Provide comprehensive grievances responses that support the decision and comply with regulatory and accreditation guidelines within regulatory timeliness.
Contact patient by phone as appropriate to reach a positive resolution.
Stay abreast of internal policies, procedures and regulations for accurate resolution of grievances.
Identify business problems and servicing issues and direct to the appropriate area for action.
Work closely with the Health Centers to ensure performance goals are met.
Understand the organization and help navigate patients through it.
Provide superior customer service to internal/external customers to ensure an exceptional customer experience.
Answer telephone calls and email inquiries regarding grievances, comment forms, website email, “we listen and social medial reviews while maintaining a professional level of telephone and email etiquette at all times.
Take messages and route calls as appropriate.
Properly identify and verify patients and clients eligibility.
Educate patients on the grievance process and direct them to their assigned health plan when appropriate.
Utilize strong judgement to identify if a grievance, question or concern has clinical components and requires clinical team for handling.
Prepare and maintain individual file folder for all cases received to include a check list and documents related to the cases.
Maintain all case files organized properly in the department electronic files.
Conduct follow up activities to ensure a response is obtained by the due date to remain in compliance.
Interface with contracted health plans to request missing information such as a provider’s name, date of service, location, etc.
Conduct relevant case research in all available systems (NextGen, Ytel, etc.)
Ensure all cases are handled and resolved in compliance with timeline requirements and the highest standards for accuracy.
Maintain confidentiality of all protected health information in accordance with the organization guidelines.
Identify barriers to customer satisfaction and timely case response and recommend actions to address operational challenges.
Manage large volumes of documents including copying, faxing and scanning.
Act as a patient liaison responsible for assisting patients with questions to resolve concerns and improve services.
Analyze all concerns, identify trends and make recommendations.
Understand the organization and help navigate patients through it.
Maintain office appearance on a daily basis.
Schedule appointments.
Copy and shred as indicated.
Provide equipment maintenance on a back-up basis.
Provide general administrative support (i.e. typing, filing, etc.).
Actively participate in all departmental meetings, training sessions, and other activities.
Performs other tasks as assigned.

Benefits

regionally competitive salary
above average health benefits at reduced costs
company paid life insurance
long-term disability insurance
additional voluntary retirement plan with company match and no vesting schedule requirement
Paid bereavement and jury duty leave
11 paid holidays per year
Paid time off
Paid sick leave
Flexible Spending Program
Company paid malpractice insurance for all providers
Professional development hours offered annually