Patient Service Representative (Clerk III)

Commence•Virginia Beach, VA

4d•Onsite

About The Position

The Patient Service Representative (Clerk III) ensures that Medicare beneficiaries are informed, updated, and assisted when necessary. The role responds to beneficiary questions, triages calls, performs case intake, and staffs the Medicare Helpline as required. It provides neutral assistance to beneficiaries, their families, and representatives while supporting the review process and helping maintain the timeliness and accuracy required by the contract and Quality Improvement Organization (QIO) manual. The position communicates with beneficiaries, healthcare providers, and other partners about Medicare and QIO activities; prepares correspondence; maintains contact information and mailing lists; processes medical records; and tracks calls, conversations, and letters using an electronic web-based application. It also enters data, contributes to continuous improvement, supports ISO audit preparation, and protects confidential information in accordance with HIPAA and HITECH. This is an in-office position with schedules that vary and may include weekend and holiday shifts.

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 healthcare provider operations and medical record documentation.
Knowledge of CMS, Medicare, and BFCC-QIO programs.
Associate degree in business education or health information management and two years of experience related to a majority of the primary duties; OR graduation from a secretarial school and three years of related experience; OR high school diploma or GED and four years of experience related to most primary duties.
Two years of experience and skill using Microsoft Word and Microsoft Excel spreadsheets.
Excellent oral and written communication skills and attention to detail.
Familiarity with database software programs, such as Microsoft Office.
Excellent interpersonal and problem-solving skills.
Ability to exercise sound judgment, organize and coordinate multiple tasks, and work in a team environment.
Ability to maintain effective working relationships and communication with providers and stakeholders.
Ability to collect data, distinguish relevant material, and maintain objectivity.
Ability to work independently and give and receive feedback.
Work well with other patient service representatives and team members and establish professional relationships within and outside the company.
Ability to work varying schedules that include weekends and holiday shifts.
Ability to sit, read, work on a computer, and watch a computer screen for extended periods; occasionally stand, walk, use hands and fingers, kneel, or crouch.

Responsibilities

Inform Medicare beneficiaries and other interested parties of their rights and responsibilities under the Medicare program.
Assist with the review process to maintain required timeliness and accuracy under the contract and QIO manual.
Act as a neutral liaison for beneficiaries, their families, and their representatives.
Inform beneficiaries, healthcare providers, and other partners about QIO activities and responsibilities.
Develop and maintain positive relationships with internal and external customers.
Prepare correspondence to physicians, facilities, and healthcare and community organizations as needed.
Obtain current and correct contact information, maintain mailing lists, and coordinate mailings.
Process and maintain medical records.
Track telephone calls, essential conversations, and letters to beneficiaries and providers using an electronic web-based application.
Enter data into software applications accurately and on time.
Participate in continuous improvement by identifying quality issues and recommending solutions.
Assist with preparation for ISO audits.
Protect beneficiary information in compliance with HIPAA and HITECH.
Attend annual security awareness, rules of conduct, and conflict of interest training.
Perform other duties as assigned.