Patient Services Representative - NBGW Specialty (Per Diem, Day)

NorthBay Healthcare Corporation•Fairfield, CA

11d

About The Position

At Northbay Health, the Patient Services Representative 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 gathers and verifies registration and insurance information, enters accurate information into the EMR, helps patients understand provider selection and financial responsibilities, verifies payer eligibility, reviews benefit plans, responds to claims and referral inquiries, and collects and reconciles payments. The role also schedules appointments, supports referral coordination, manages provider schedules and patient access, and welcomes patients. It handles patient documents and medical records in accordance with confidentiality policies, PHI-management practices, and HIPAA requirements. The representative may serve as a subject-matter resource, orient staff, float to other areas, and perform other assigned duties. Hours are based on business need.

Requirements

Two years of customer-engagement experience and/or experience in a service-centered role.
Current AHA or equivalent BLS certification required within the first 90 days of hire.
Excellent customer-service skills.
Excellent oral and written communication skills, including the ability to articulate thoughts in productive and meaningful discussions.
Ability to manage multiple priorities effectively within expected timeframes.
Working knowledge of Medi-Cal, Medicare, managed care, indemnity, and workers’ compensation insurance characteristics.
Working knowledge of how accurate and complete registration affects claims processing, payment, and 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.
Empathy, optimism, resourcefulness, and cultural competency in interactions with others.
Willingness to learn and collaborate with others.
A track record of conduct demonstrating understanding of the complexities and challenges of the healthcare environment.
Strong organizational skills.
Ability to walk, bend, stoop, and lift, and to use a computer keyboard extensively throughout the day.
Ability to meet attendance expectations, which are 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, referrals and authorizations, registration, and back-office clinical support.

Responsibilities

Gather, update, and verify registration and insurance/payer information and enter it accurately into the EMR.
Provide patients information about care-provider selection, insurance eligibility, copayments, 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 and restrictions for requested services.
Research and respond to inquiries about claims, eligibility, and referrals.
Collect copayments, deposits, and fees and reconcile payments at the end of the shift.
Maintain accurate demographic and insurance information in accordance with departmental policies and procedures.
Participate in committees, in-services, quality-improvement activities, and standards development.
Serve as a subject-matter resource, provide orientation to new staff as assigned, and float to other areas as requested.
Obtain and update patient demographic information and, when applicable, confirm eligibility and primary-care-provider assignment before scheduling.
Determine appropriate call routing using listening and problem-solving skills.
Schedule appointments by phone or in person according to approved protocols, policies, procedures, and algorithms.
Assist with specialty-care referral coordination and scheduling.
Monitor provider schedules to ensure appointments have the correct type and time allocation, and proactively support patient access and no-show reduction.
Make confirmation or rescheduling calls according to applicable scripts and procedures.
Assist with physician schedule maintenance, including coordinating absences with open appointment times.
Gather data for provider-access audits and provide appointment-access information for KPIs.
Greet and welcome patients and assist with questions about appointments, payments, and schedules.
Follow system policies for medical-record confidentiality, transcription, copying, and distribution; handle patient documents appropriately, including records outside designated storage areas.
Demonstrate understanding of PHI management and HIPAA compliance through annual competency validation.
Perform other duties as assigned.