Patient Services Rep (Full-Time, Day)

NorthBay Healthcare Corporation•Fairfield, CA

About The Position

At NorthBay Health, the Patient Services Representative II performs general front office duties of moderate scope and complexity, including reception, registration, appointment scheduling, insurance verification, and medical records management. The role exercises judgment within defined guidelines and works as part of a clerical and customer service team supporting Ambulatory Division medical practices. The representative performs all Level 1 duties independently and also handles more complex registration and charge-entry work, including gathering and verifying registration and payer information, entering accurate information into the EMR, explaining insurance eligibility and patient financial responsibilities, obtaining required signatures, and collecting and reconciling payments. The role also supports appointment scheduling and reception, referral coordination, provider schedule management, and patient access activities. The position maintains confidentiality and appropriate handling of medical records and patient documents, follows HIPAA and system policies, and contributes to staff orientation, committees, in-services, quality-improvement activities, and standards development. The representative may float to other areas and perform other assigned duties.

Requirements

Two years of customer engagement experience and/or experience in a service-centered role.
Excellent customer service skills.
Excellent oral and written communication skills, including the ability to articulate thoughts effectively in productive discussions.
Ability to manage multiple priorities effectively within expected timeframes.
Working knowledge of the distinguishing characteristics of Medi-Cal, Medicare, Managed Care, Indemnity, and Workers Compensation insurance.
Working knowledge of how accurate and complete registration/admission affects claims processing and payment.
Working knowledge of how accurate and complete registration affects safe, high-quality patient care.
Working knowledge of organizational processes and procedures and NorthBay Health clinical computer systems.
Demonstrated service excellence, including professionalism, customer focus, compassion, strong listening skills, and a warm demeanor.
Consistently demonstrate empathy, optimism, resourcefulness, and cultural competency in interactions.
Willingness to learn and collaborate with others.
Demonstrated understanding of the complexities and challenges of the healthcare environment.
Strong organizational skills.
Current AHA or equivalent BLS certification is required within the first 90 days of hire.
Ability to meet the physical demands of walking, some bending and stooping, lifting, and extensive computer keyboard use; attendance is an essential function of the job.

Nice To Haves

Some college business or computer coursework.
Coursework in medical terminology.
Healthcare-environment experience with medical-record processes, appointment scheduling, referral and authorization processes, registration, and back-office clinical support.

Responsibilities

Perform all Level 1 duties independently.
Gather, update, and verify registration and insurance/payer information and enter it accurately into the EMR.
Provide patients with information about care-provider selection, insurance eligibility, co-payments, share of costs, and other financial responsibilities.
Obtain signatures on required forms and verify and document payer eligibility at the time of service.
Review benefit plans with patients to determine allowances or restrictions for requested services.
Research and answer inquiries related to claims, eligibility, and referrals.
Collect co-payments, deposits, and fees, and reconcile payments at the end of the shift.
Ensure demographic and insurance information is accurate and complies with departmental policies, procedures, and service expectations.
Participate in committees, in-services, quality-improvement activities, and standards development.
Serve as a subject-matter resource and job expert; provide orientation to new staff as assigned.
Float to other areas as requested and perform other duties as assigned.
Obtain and accurately enter demographic information for new patients and confirm or update information for existing patients.
Confirm eligibility and primary care provider assignment status when applicable before scheduling.
Use listening and problem-solving skills to route calls appropriately.
Schedule appointments by phone or in person according to approved protocols, policies, procedures, and algorithms.
Assist with referral coordination and scheduling for Specialty Care.
Monitor provider schedules to ensure appointments use the correct type and time allocation.
Manage provider schedules proactively to support patient access and reduce no-shows.
Make appointment confirmation or rescheduling calls in accordance with scripted guidelines and current policies and procedures.
Assist with physician schedule maintenance, including coordinating physician absences with open appointment times.
Gather provider-access audit data and provide appointment access for KPIs.
Greet and welcome patients and answer initial questions about appointments, payments, and schedules.
Follow system policies on medical-record confidentiality, transcription, copying, and distribution.
Handle patient documents appropriately, including medical records outside designated storage areas, to protect confidentiality.
Demonstrate understanding of PHI management and HIPAA compliance through successful completion of annual competency validation.