Patient Service Representative (Manhattan)

JOB SUMMARY: The Patient Services Representative (PSR) provides day-to-day front/back-end support to patients and the clinical team under FQHC Article 28 and the Patient-Centered Medical Home (PCMH) model. The PSR will obtain and verify patient demographic, insurance, and income information to ensure accurate and timely visit processing and reimbursement. The PSR will also check patients in and out of their face-to-face or telemedicine visits, schedule follow-up appointments, and process referrals and authorizations. The PSR will work as part of our PCMH team. with the following essential duties and responsibilities:

ESSENTIAL DUTIES AND RESPONSIBILITIES OF A PATIENT SERVICES REPRESENTATIVE:

• Collaborate with clinical and administrative teams to ensure patients receive patient-centered quality health care.
• Provide clerical and administrative support to patients and Practitioners; support may occur in-person, via telephone, fax, or patient portal (web-encounters).
• Greet patients and visitors, take and relay messages to the patient’s care team, liaise between patients, CFH, and off-site service providers such as specialty and radiology providers.
• Participate in process improvement committees, training, and staff meetings, as needed

Patient Registration, Documents, and Insurance Verification

• Register new patients to their preferred CFH site and/or update existing patient accounts.
• Ensure the patient completes all patient forms, including but not limited to registration forms, sliding fee scale self-declaration and acknowledgment, consents for treatment, Health Insurance Portability and Accountability Act (HIPAA) form, and Advanced Directives.
• Obtain and scan copies of patient documents including but not limited to photo identification card(s), insurance card(s), referrals, consults, and emergency room discharge summaries.
• Accurately input/update patient demographic information to eCW, including, but not limited to patient’s name, birth date, address, telephone, email, insurance (medical, dental, vision), income and family size, housing status, veteran status and sexual orientation/gender identity.
• Web-enable all patients for access to their patient portal, as per CFH policy.
• Screen all patients (insured, uninsured, underinsured) for the sliding fee scale, and update patient income and family size in eCW to reflect the appropriate sliding fee scale.
• Collect payments, co-payments or sliding fees under CFH policy.
• Waive the collection of payments, co-payments or sliding fee, as needed, following CFH policy.
• Refer all uninsured or underinsured patients to CFH Certified Application Counselors (CAC) to be screened for insurance eligibility.
• Verify patient’s medical, dental or visit insurance(s) to ensure coverage is active on the date of services, including but not limited to Medicaid, Medicaid Managed Care, Medicare, Medicare Managed Care, and Private or Commercial plans.
• Utilize insurance eligibility/verification portals to retrieve accurate patient insurance information, including but not limited to, ClaimRemedi, ePACES, eviCore, Managed Care and/or Private/Commercial individual portals.
• Add, modify or update the patient’s medical, dental and vision insurance information to eCW.
• Ensure the appropriate medical, dental, and vision insurance is associated with the patient’s visit on the date of service.
• Assist patients with assigning their Managed Care plan’s Primary Care Provider (PCP) to CFH provider, as needed.
• Assist patients with assigning their Managed Care plan’s Dental Provider to CFH provider, as needed.
• Check-in patients to their face-to-face or telemedicine visits upon verification of all mandatory patient fields, insurance(s), and sliding fee scale.

Appointment Scheduling

• Manage requests for new, follow-up, routine care, offsite specialist or radiology appointments as requested by the Practitioner or patient; requests may be received in-person, via telephone, fax, or patient portal.
• Reschedule appointments as requested by the Practitioner or patient.
• Update the appointment visit status to reflect the appropriate stage of the patient visit.
• Maintain the Practitioner’s resource schedule by rescheduling appointments as needed when a Practitioner is on scheduled time off or absent.
• Schedule follow-up appointments as indicated by the Practitioner.

Specialty Referral/Diagnostic Imaging Order(s)

• Ensure all insurance and demographic information is appropriately documented within the patient’s specialty referral or diagnostic imaging order.
• Liaise with CFH Referral Specialist to ensure specialty referrals are processed promptly.
• Provide copies of the specialty referral or diagnostic imaging order via the patient’s preferred method (mail, fax, patient portal).

Visit Processing

• Check-in visits upon patient’s arrival to CFH site or virtual waiting room.
• Check-out visits upon the completion of the patient’s visit with the Practitioner.
• Ensure follow-up appointments are scheduled as documented by the Practitioner within the “Follow Up” section of the progress note.

Telemedicine/Web-Encounters

• Manage/respond to assigned site’s web encounters to ensure timely processing.

Required Education & Experience:

• High School Diploma.
• Minimum two (2) years’ experience in ambulatory care setting, Emergency Room, and/or Physician office.
• Bilingual English & Spanish

Preferred Education & Experience:

• Associate degree, in healthcare-related discipline preferred.
• Prior experience utilizing eClinicalWorks.

Skill Sets:

• Excellent organizational and communication skills required.
• Excellent verbal and written communication skills required.
• Excellent punctuality and attendance required.
• Consistent demonstration of commitment to patient satisfaction, organizational productivity and process improvement.
• Ability to work independently, maintain efficiency and productivity required.
• Ability to multi-task and meet assigned deadlines from a variety of management staff.
• Ability to work in a fast-paced and ever-changing environment.
• Demonstrates initiative, personal awareness, professionalism and integrity, and exercises confidentiality in all areas of performance.
• Follows HIPAA, compliance, privacy, safety and confidentiality standards always.
• Extremely proficient in Microsoft Office Suite applications, including but not limited to Outlook, Word, Excel, and SharePoint.
• Ability to work and remain calm in moderate to high stress environment.