Patient Services Representative

Job Description

Job Description:\n\n \nPosition Title: Patient Services Representative\nDepartment: Front Office\nSite: Carevide Kaufman\n\nPurpose of Position:\nThe purpose of the Patient Services Representative position is to support the delivery of high-quality, patient-centered care in a family practice setting by serving as a welcoming, knowledgeable, and reliable first point of contact for patients and their families or caregivers. This role ensures efficient front office operations that promote access to care, positive patient experiences, and the financial sustainability of the health center through accurate, compassionate, and professional administrative support.\n\nContribution to Carevide’s Mission:\nThe Patient Services Representative plays a vital role in advancing the health center’s mission by creating a welcoming, safe, and family-centered environment for patients and their families or caregivers. As the first and last point of contact, this position helps set the tone for each visit by demonstrating warmth, patience, and professionalism in every interaction.\nAccess to Patient & Family-Centered, High Quality Care: This role supports access to high-quality, patient-centered care in a family practice setting by assisting individuals and families with scheduling, insurance, referrals, and administrative processes clearly and compassionately, recognizing that patients, families and caregivers may be navigating stress, time constraints, or complex systems. Through culturally sensitive and compassionate interactions, the Patient Services Representative helps build trust with patients, families and caregivers, reduces barriers to care, and supports positive, long-term relationships that promote patient’s health and well-being. By collaborating closely with clinical teams and upholding the organization’s values, the Patient Services Representative contributes to a positive patient experience and helps ensure that every patient and family feels respected, supported, and cared for.\nFinancial Success & Sustainability of the Mission: The Patient Services Representative supports the financial sustainability of the health center by ensuring accurate and timely collection of patient information, insurance details, and required documentation. By helping patients, families and caregivers understand coverage, eligibility, and financial processes clearly and respectfully, this role reduces barriers to care while supporting appropriate reimbursement for services provided. Through attention to detail, effective communication, and collaboration with billing and clinical teams, the Patient Services Representative helps minimize errors, delays, and insurance claim denials that can impact revenue. By fostering positive, trusting relationships with patients, families, and caregivers and encouraging continuity of care, this role contributes to patient retention and the long-term financial health of the family practice center, ensuring the health center can continue to serve patients and families in the community.\nEssential Responsibilities of Check-in\nPosition Summary\nCheck-in is responsible for delivering a high-quality, patient-centered experience by managing front desk operations, coordinating patient check-in, and ensuring accurate registration, and payment collection. This role plays a critical part in maintaining efficient clinic flow, data accuracy, and compliance with Carevide’s policies.\nPatient Experience & Customer Service \n\n Greet patients, families and caregivers in a professional, patient-centered manner and assist with questions or concerns. \n Utilize the AIDET customer service model to ensure patients and caregivers are consistently acknowledged and informed throughout their visit. \n Maintain professionalism in managing patient concerns, conflicts, or lobby disturbances and notify the supervisor when necessary. \n Identify and escalate any potentially infectious patients upon arrival following clinic protocols. \n Coordinate and notify staff of time-sensitive visits, including proper workflows for rooming “48-hour babies.” \n Direct patients to the appropriate waiting area based on visit type (ex: well vs. sick). \n Monitor patient progress through registration process and assist patient, or caregiver in maintaining efficient clinic flow. \n\nPatient Registration & Intake Management\n\n Verify patient identity using appropriate identifiers to ensure accurate account and chart access. \n Actively manage the Phreesia dashboard icons (up to 5 days prior to visit) by accepting completed data and addressing incomplete registrations, missing photos, skipped steps, and incomplete interviews. \n Monitor pre-visit and in-office registration status to ensure completion of demographics, insurance, and required consent/policy forms. \n Ensure all required registration documents, based on visit type, are completed and validate all demographic and financial information is properly imported into Nextgen prior to check-in. \n Identify patients requesting to be screened for the Sliding Fee Discount Program and flag appointment on Phreesia dashboard for eligibility.\n Review pre-registration details and flagged patient appointments on Phreesia dashboard to identify if additional financial information or PCP change is required prior to check in; direct to eligibility as appropriate. \n Capture patient photos in accordance with organizational procedures. \n Collect and copy valid IDs and current insurance cards (front and back) when not obtained during the electronic registration process. \n Track and update patient visit status in Nextgen EHR (e.g., waiting on eligibility, ready for nursing). \n Process patient visits through the Phreesia intake and registration dashboard. \n Complete Nextgen autoflow check-in process, ensuring current insurance payer(s) is attached and sliding fee scale status is updated. \n\nScheduling & Appointment Coordination\n\n Assist patients and caregivers of walk-in patients with scheduling same-day or future appointments as needed\n Perform daily appointment confirmation calls the day prior to scheduled visits and clearly communicate the following to the patient or caregiver: \n \n Completion of registration documents prior to appointment\n Expected payment amounts\n Required documentation needed for financial screening (ex: proof of income) or billing of insurance\n \n\nPayment Collection & Account Management\n\n Collect and post patient payments, including co-pays, co-insurance, and sliding fee amounts through Phreesia. \n Provide the patient or caregiver with a receipt for all collected payments. \n Follow Carevide’s collection policies for patients unable to pay at time of service. \n Inform patients or caregivers of outstanding balances from previous visits. \n Review accounts for credit balances and coordinate with the billing team to apply credits as appropriate. \n Reconcile daily cash and check collections against Phreesia system reports to ensure accuracy. \n\nReporting & Administrative Responsibilities\n\n Run, review, and correct assigned daily reports within Nextgen (Daily Report Folder) \n Participate in scheduled lobby checks and communicate delays or extended wait times to patients. Lobby checks to be completed at 9:00a, 11:00a, 2:00p & 4:00p.\n Collaborate with front office team members to maintain a clean, organized, efficient, and patient-focused environment.\n\nEssential Responsibilities of Check-out\nPosition Summary\nCheck-out is responsible for ensuring accurate and efficient patient check-out, charge review, payment collection, and scheduling of follow-up care. This role plays a key part in revenue cycle integrity, patient satisfaction, and maintaining smooth clinic operations through effective communication, attention to detail, and adherence to organizational policies.\nPatient Experience & Customer Service\n\n Greet patients, families and caregivers in a professional, patient-centered manner and assist with questions or concerns. \n Utilize the AIDET customer service model to ensure patients and caregivers are consistently acknowledged and informed throughout their visit. \n Assist patients or caregivers with registration intake process if needed in maintaining efficient clinic flow.\n Provide a positive closing experience by thanking patients and caregivers for choosing Carevide for their healthcare needs or some other expression of gratitude.\n\nCheck-Out & Charge Processing\n\n Verify patient identity using appropriate identifiers to ensure accurate account and chart access\n Complete the auto-flow check-out process in Nextgen, ensuring all visits are properly finalized with the current insurance attached if applicable.\n Review charges submitted from the EHR for accuracy and completeness, confirming all visits include the appropriate office visit charge. \n Track visits as “waiting for charges”, if incomplete, and collaborate with providers and/or Practice Manager to ensure all charges are submitted by end of day. \n Prepare charges for claim submission based on payer requirements, including: \n \n Adding appropriate modifiers \n Removing outside lab charges when applicable \n \n Update visit status to “checked-out” once all processes are completed. \n\nPayment Collection & Reconciliation\n\n Collect remaining patient balances at time of service, including co-pays, co-insurance, and outstanding balances if applicable. \n Provide the patient or caregiver a receipt for all payments collected. \n Follow Carevide’s collection policies for patients unable to pay at time of service. \n Reconcile and balance cash and check payments against Phreesia system reports at designated times throughout the day. \n\nScheduling & Follow-Up Coordination\n\n Schedule follow-up and return appointments as indicated in Nextgen. \n Provide patients or caregivers with detailed appointment reminder card for scheduled visits.\n Assist patients, families and caregivers of walk-in patients with scheduling same-day or future appointments as needed\n\n \n \nRegistration Support & Data Accuracy\n\n Actively monitor and work assigned tasks within the patient registration platform (e.g., Phreesia), addressing incomplete interviews, missing documentation, and patient photos as needed. \n Review and correct Primary Care Provider (PCP) assignments within Nextgen based on Carevide’s procedure.\n\nReporting & Administrative Responsibilities\n\n Ensure accuracy and completeness of documentation related to check-out and billing processes. \n Run, review, and correct assigned daily reports within Nextgen (Daily Report Folder) \n Participate in scheduled lobby checks and communicate delays or extended wait times to patients. Lobby checks to be completed at 9:00a, 11:00a, 2:00p & 4:00p.\n Collaborate with front office team members to maintain a clean, organized, efficient, and patient-focused environment.\n\n \nEssential Responsibilities of Eligibility\nPosition Summary\nEligibility is responsible for verifying insurance coverage, determining financial eligibility, and ensuring accurate patient financial information prior to and during visits. This role supports revenue cycle integrity and patient access to care by managing pre-registration, eligibility verification, and financial screening processes, including the Sliding Fee Discount Program. The position requires strong attention to detail, excellent communication skills, and a commitment to delivering a patient-centered experience.\nPatient Experience & Customer Service\n\n Greet patients, families and caregivers in a professional, patient-centered manner and assist with questions or concerns. \n Utilize the AIDET customer service model to ensure patients and caregivers are consistently acknowledged and informed throughout their visit. \n Verify patient identity using appropriate identifiers prior to discussing protected health or financial information. \n Maintain confidentiality and professionalism when discussing sensitive financial and insurance information. \n\nInsurance Verification & Eligibility Management\n\n Perform daily pre-registration processes to verify current insurance coverage and financial eligibility status. \n Review all scheduled patients, on Phreesia dashboard, 6–7 days in advance to ensure accurate insurance verification and financial responsibility amounts prior to patient notifications. \n Monitor Phreesia dashboard daily for newly scheduled patients to verify insurance coverage and confirm accurate co-pay/co-insurance amounts. \n Verify insurance eligibility 2–3 days prior to appointments, including: \n \n Coverage status and benefits\n Primary Care Provider (PCP) assignment \n Primary and secondary coverage \n Patient financial responsibility (co-pay/co-insurance) \n \n Contact patient or caregiver to obtain missing or updated insurance information and facilitate PCP changes when needed. \n Ensure current insurance cards (front and back) are on file in the patient chart. \n Add new insurance payers and terminate inactive coverage within Nextgen.\n\nPhreesia Dashboard & Pre-Registration Management\n\n Actively monitor & manage the Phreesia dashboard icons, addressing updates related to: \n \n Insurance information changes and uploaded cards \n Financial screening requests\n Financial screening documentation (ex: Proof of Income) \n \n Update financial details in Nextgen, flag patients requiring eligibility review, and ensure accuracy of pre-registration data in Phreesia. \n Retrieve insurance information for new patients; process verification and contact patient or caregiver to explain benefits and/or patient cost share.\n\nFinancial Screening & Sliding Fee Program\n\n Conduct financial screenings in a confidential setting to determine eligibility for available grant programs offered at Carevide. \n Ensure documentation and/or application for screened grant program(s) is complete, current, and accurate, including proof of income or required documentation is received. \n Completion of warning letter if documentation of income is not provided.\n Update patient chart with current family size and income data obtained during financial screening process. \n Clearly explain to the patient or caregiver the purpose of the financial screening process and benefits of the grant programs offered at Carevide. \n Identify and refer patients who may qualify for Medicaid/CHIP to Outreach & Enrollment staff. \n\nPayment Collection & Account Management\n\n Collect and post patient payments, including co-pays, co-insurance, and sliding fee amounts through Phreesia. \n Provide the patient or caregiver with a receipt for all collected payments. \n Follow Carevide’s collection policies for patients unable to pay at time of service. \n Inform patients or caregivers of outstanding balances from previous visits. \n Review accounts for credit balances and coordinate with the billing team to apply credits as appropriate. \n Reconcile daily cash and check collections with Phreesia collection reports to ensure accuracy. \n\nClinic Flow & Visit Processing\n\n Track and update patient visit status in Nextg