Patient Services Representative-Ambulatory

Alameda Health System•San Leandro, CA

About The Position

Under general supervision, the Patient Services Representative provides specialized clerical support to clinic registration units and screens patients for potential eligibility for financial assistance programs. The role performs patient registration and less complex enrollment of eligible patients in programs including the Childhood Health and Disability Program (CHDP), AHS Charity Program, Presumptive Eligibility (PE), and Cancer Detection Program (CDP). Patient Services Representatives also support day-to-day clinic operations as part of the ambulatory care team and may work at alternate locations as needed. The position provides patient-centered customer service, coordinates registration and scheduling, gathers and processes billing and financial-screening information, verifies coverage, and assists patients with applications for financial assistance. It also supports referrals and authorizations, communicates with patients and healthcare staff, maintains records, performs outreach, and participates in quality improvement activities.

Requirements

High school diploma or equivalent.
Demonstrated ability to use computer and telephone systems and navigate application systems.
Ability to empathize with vulnerable populations and underserved patients.

Nice To Haves

Knowledge of medical terminology.
Bilingual ability.

Responsibilities

Provide respectful, patient-centered care and excellent customer service to internal and external customers.
Collaborate with patients and healthcare providers to support coordinated, high-quality care.
Register and preregister patients for ambulatory care services; interview patients to obtain billing and financial-screening information, establish payment sources, and prepare registration packets and visits.
Schedule appointments in person and by phone.
Advise patients or guarantors of financial obligations; collect and process payments, copayments, and prepayments.
Verify insurance program eligibility and coverage for ambulatory care services.
Explain applicable federal, state, and county program rules, eligibility requirements, and patient rights and obligations; help patients complete applications and forms and review them for accuracy and completeness.
Enter registration and billing information into computer systems, retrieve data, and prepare reports related to patient census, insurance, and financial status.
Distribute, complete, and collect forms and documents; explain available services and resources and determine enrollment options for eligible patients in financial assistance and health coverage programs.
Maintain records of unit productivity, patient location, registration, and discharge.
Inform medical providers of patients' financial status and communicate with providers and staff about conditions or diagnoses that may qualify patients for assistance programs.
Respond to inquiries about AHS healthcare services, explain AHS and ambulatory care policies and procedures, and direct patients to appropriate service areas.
Process referrals and submit required authorization and prior-authorization forms to health plans or medical/provider groups as directed by the referring provider.
Generate required correspondence and review notifications to patients and providers regarding authorization determinations or barriers to scheduled services, including self-pay, continuity of care, or cancellation.
Conduct outreach to support AHS organizational goals and initiatives.
Operate standard office equipment and AHS applications, including electronic health record, financial billing and registration, and online resources; use telephone and email to communicate with patients and AHS employees.
Provide backup and coverage for Ambulatory Care Services as assigned.
Participate in performance improvement and quality control activities.
Perform related duties as assigned.