Patient Representative Jobs

About The Position

Requirements

• High school diploma or GED, or at least six months of specialized training, education, or experience.
• At least six months of experience in a related field.
• Ability to read and comprehend simple instructions, short correspondence, and memos; write simple correspondence; and present information effectively in one-on-one and small-group situations.
• Ability to perform arithmetic using whole numbers, fractions, and decimals; compute rates, ratios, and percentages; and interpret bar graphs.
• Knowledge of database software.
• Ability to use common-sense understanding to follow written, oral, or diagrammatic instructions and solve problems involving several concrete variables in standardized situations.
• Ability to perform the essential duties satisfactorily; reasonable accommodations may be made for individuals with disabilities.

Nice To Haves

• Experience with Medicaid, Medicare, and third-party billing and guidelines.

Responsibilities

• Greet and assist patients and visitors courteously in person and by phone; respond to general problems or complaints, make appointment reminder calls, and refer calls or take accurate messages.
• Determine eligibility for patients new to Cherokee Nation Health System by obtaining a Certification of Degree of Indian Blood card or other documentary proof of tribal membership in a federally recognized tribe.
• Help patients complete new or updated forms and obtain required signatures for inpatient, outpatient, emergency, and after-hours services.
• Interview new and existing patients to collect registration information, including by phone for pre-registration.
• Verify patient billing information through automated processes, registration interfaces, and contact with patients or payers.
• Scan third-party health cards and explain the need for the facility to bill for services rendered.
• Maintain knowledge of and comply with the Privacy Act, HIPAA, and other applicable patient confidentiality requirements.
• Enter Medicare, Medicaid, and private or commercial insurance information into electronic records systems.
• Review notes and communicate with Patient Benefits Advocates or Coordinators to exchange billing information and coordinate eligibility and benefits.
• Schedule, cancel, and reschedule appointments; maintain scheduling designations and queues to support timely scheduling.
• Use the automated appointment reminder application and reports daily.
• Ensure appointment slots have time allotments appropriate to medical staff direction.
• Send clinic or department correspondence to patients.
• Meet acceptable production and quality assurance standards and complete daily productivity log forms.
• Serve as a front-line contact for patients and direct inquiries to appropriate personnel, including medical staff.
• Use computerized programs and databases to enter, modify, and retrieve sensitive information in electronic health record, scheduling, registration, and reporting applications.
• Monitor scheduling queues and wait lists so referrals are handled appropriately and promptly.
• Assess patient status and obtain authorization for hospitalization and outpatient services before services are rendered.
• Provide retroactive reviews and appeals to insurance companies as needed.
• Answer calls from insurance companies, physician offices, hospitals, and patients with exemplary customer service.
• Document pre-certification numbers in electronic health record applications and designated locations for access by other departments.
• Coordinate with providers, case management, insurance carriers, patient access billing, and patients to secure authorizations, payments, or services.
• Expedite emergency-based referrals when recommended by medical personnel.
• Communicate politely and effectively with patients when rescheduling appointments.
• Verify patient demographic, insurance, emergency contact, and eligibility information for accuracy and completeness.
• File and retrieve applications and records, research missing records, tabulate data, and assemble or repair records and files according to established procedures.
• Order and issue supplies as appropriate.
• Operate copiers, fax machines, and other office equipment.
• Assist and train other or new team members.
• Follow supervisor-established call-in procedures.