Patient Service Representative (Clerk III) | Medicare

Commence•Virginia Beach, VA

8d•Onsite

About The Position

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

Requirements

Experience as a call center representative or patient service representative.
Considerable knowledge of business English, medical terminology, spelling, punctuation, vocabulary, filing, and general office methods.
Working knowledge of the healthcare provider business and all the components of medical record documentation.
Knowledge of Centers for Medicare & Medicaid Services (CMS), Medicare, and the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) programs.
Two years of experience and skill in Microsoft Word and Microsoft Excel spreadsheet programs.
Excellent oral and written communication skills.
Attentive to detail.
Familiarity with database software programs (e.g., Microsoft Office).
Excellent interpersonal and problem-solving skills.
Essential knowledge of medical terminology and components of medical record documentation.
Working knowledge of CMS, Medicare, and the QIO programs.
Ability to exercise sound judgment.
Ability to organize and coordinate multiple simultaneous tasks in a team environment.
Ability to maintain effective working relationships and communications with providers and stakeholders.
Ability to collect data and distinguish relevant material.
Ability to maintain objectivity.
Ability to work independently.
Ability to give and receive feedback.

Nice To Haves

Works well with other patient service representatives and team members.
Establishes and maintains good professional relationships with people on all levels within Company and physicians and others outside of Company.

Responsibilities

Ensures that Medicare beneficiaries are informed, updated, and assisted when necessary.
Responds to questions from beneficiaries, triages beneficiary calls, performs case intake, and staffs the Medicare Helpline as required.
Informs Medicare beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program.
Assists with the review process to maintain required timeliness and accuracy as stipulated by the contract and the Quality Improvement Organization (QIO) manual.
Acts as a neutral liaison for beneficiaries, their families, or their representatives.
Informs Medicare beneficiaries, healthcare providers, and other partners of the activities and responsibilities of the QIO.
Develops and maintains positive relationships with external and internal customers.
Prepares correspondence to physicians, facilities, and other healthcare and community organizations as needed.
Ascertains the most current and correct contact information, maintains accurate mailing lists, and coordinates mailings.
Processes and maintains medical records.
Tracks all telephone calls, essential conversations, and letters mailed to beneficiaries and providers using an electronic web-based application.
Enters data into software applications timely and accurately.
Participates in the continuous improvement process to identify quality issues and recommends solutions.
Assists in preparation for International Standardization Organization (ISO) audits.
Protects the confidentiality of beneficiary information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH).
Attends annual security awareness, rules of conduct, and conflict of interest training.
Performs other duties as assigned.