Patient Services Representative

BioTAB Healthcare•St. Louis, MO

4d•Onsite

About The Position

For over 20 years, BioTAB Healthcare, LLC has provided treatment solutions for patients with lymphatic, wound, and circulatory disorders. As a family-owned company based in Missouri, BioTAB offers pneumatic compression devices and personalized service to enhance patient outcomes and quality of life. The Patient Services Representative role is centered on prioritizing the patient in every interaction. This position involves processing clinical paperwork from the sales team, reviewing coverage requirements under private health insurance and CMS, and researching patient benefits to secure product approvals for orders. Daily interactions will occur with patients, sales teams, sales leadership, clinicians, and internal departments, utilizing incoming and outgoing calls, emails, CRM, Provider systems, fax, and Vendor portals. The representative will manage all documentation for patient charting, shipping, and cost, ensuring a seamless patient experience. This role reports to team Managers and Directors and demands exceptional attention to detail, strong customer service skills, and a focus on process execution and quality control.

Requirements

Strong communication and interpersonal skills to interact effectively with patients, families, and healthcare professionals
Ability to work independently and as a team member, take direction and participate in Continuous Education as required for the role
Excellent organizational and time management skills to manage a high volume of tasks and ensure timely processing of information
Attention to detail to ensure accuracy in patient records and insurance information
Ability to multitask and prioritize duties to support delivery of high-quality patient experience
Knowledge of healthcare regulations and insurance processes to navigate the complexities of DME care
Problem-solving skills to address any issues or challenges that may arise during the work process
High School or equivalent
Must be able to use SalesForce or Epic, fax, email, GSuite or Office, in/outbound calls with appropriate grammar, spelling and punctuation
Strong communication skills, both written and verbal
Comfortable handling sensitive and confidential Information (HIPAA)
Reliable work transportation
Candidates must pass an extensive background check
Strict adherence to HIPAA, Medicare Fraud, Waste, and Abuse and privacy regulations in all patient interactions

Nice To Haves

Associate's or Bachelor’s degree
1+ years of experience in healthcare operations, customer service, or similar role or setting

Responsibilities

Handle benefits and prior-authorizations
Perform case review and process documentation
Manage appeals
Conduct order review and confirmation
Process re-certifications
Handle re-work
Interface with Parachute
Interface with TMs and Bonafide calls
Call clinics / patients to discuss cases and documentation
Process cases timely, in line with departmental-determined metrics per month
Complete case tasks
Cover pre-authorizations, research coverage and enter notes
Review order criteria, SWO and identify requirement failures
Match insurance, review coverage and discuss with patients
Review notes, update the CRM against case requirements
Participate in designated departmental training sessions
Participate in a one-hour per month Scribe or Google Meet session, to be completed during regular work hours
Receive and process new patient referrals, gathering necessary demographic, medical, and insurance information (Patient Intake)
Conduct outbound and inbound professional communications, interface with BPO partners and quality control measures for patient intake
Verify patient insurance coverage and benefits for BioTAB products, update cases accordingly for record keeping and internal Insurance Database (Insurance Verification)
Verify patient benefits with insurance companies and manage utilization review activities, requests and obtain prior authorizations from insurance providers
Collaborate with sales, patients and their caregivers / healthcare professionals to ensure patient products are covered, shipped and in use (Coordination)
Provide administrative support as needed, including assistance with documentation, communication, and clerical tasks
Answer incoming calls to services lines and provide patient support, answer questions and document interactions and resolutions in CRM (Process Management)
Escalate any urgent requests and direct to correct departments or Leaders
Maintain clear and effective communication with patients, families, and other healthcare team members
Provide strong customer service, responding quickly and appropriately to patient needs, and manage potentially difficult or emotional situations
Ensure accurate and timely documentation of all case activities and patient information in the required system (Record Management)
Maintain accurate and organized records of client interactions, service plans, and case management activities
Create and manage electronic consent forms; upload signed forms to patient charts
Complete forms, produce reports on client progress and service delivery, and ensure compliance with organizational policies and regulatory requirements
Ensure compliance with relevant healthcare regulations, financial standards, and internal policies (Compliance)
Prepare cases and escalations for Review and other regulatory agencies, assisting in monitoring compliance with Medicare regulations
Adhere to all relevant regulations and agency policies regarding patient intake and data management, including CMS and OFCCP guidelines related to Quality Management System, documentation and process creation and training