Medical - Patient Services Representative - Full-Time (On-Site)

Patient Services Representative

We are an FQHC community health center dedicated to embodying the values central to American Indian cultures. This includes respect for our patients, acknowledgement of the whole person, and a focus on working together to ensure health for the individual, and therefore the community. We invite persons of all tribes, ethnic backgrounds and walks of life to experience the comprehensive care we deliver and to contribute to the services we provide for children, youth, families, adults, and elders.

This position serves as the Patient Services Representative for San Diego American Indian Health Center. The role is integral to providing outstanding patient care by warmly welcoming patients, efficiently managing incoming calls, overseeing registration and appointment scheduling. Additionally, the representative ensures accurate insurance verification and clearly communicates financial responsibilities to patients. The position is also responsible for updating patient information, required administrative forms, and documentation in both the Resource and Patient Management System (RPMS) and Electronic Health Records (EHR). In addition to these core duties, this role includes performing a variety of clerical tasks to support the smooth operation of the medical department.

Must be able to demonstrate knowledge and skills necessary to perform all job-related activities as outlined below.

Essential Duties and Responsibilities:

Primary Functions:

1. Warmly greet patients in a courteous and respectful manner while maintaining a clean, safe and comfortable reception area and patient lobby.
2. Process new patient registration in accordance with billing and medical records guidelines.
3. Ensures accurate verification and data entry of patient demographics insurance information, and scanning of required clinical and administrative forms, screening and processing of applications for medical programs CHDP/EWW/FPACT/SFS/RHAP) and correct entry of clinical codes during check in.

Primary Functions: continue

1. Gather patient information for walk in triage by completing a triage slip (including patient's name, HRN #, DOB, chief complaint, payer source), verify insurance eligibility and benefits, and collects necessary administrative and clinical forms following medical department procedures.
2. Collects payments for outstanding balances, co-pays, and services provided at the time of service and provides patients and the fiscal department with accurate receipts in accordance with fiscal guidelines.
3. Makes next patient appointments in accordance with medical scheduling templates and scheduling guidelines established by the Medical Director.
4. Answers incoming calls and ensure new patient appointments, appointment cancellations and rescheduling of appointments are completed in a timely manner. Ensure voicemail messages and return phone calls are completed promptly according to the front desk process and guidelines.
5. Maintains schedules updated with current status throughout the business day, assures no-shows are coded and patients are checked-in and out in a timely manner in accordance with medical department guidelines and process.
6. Performs "end of day" duties:
7. Double checks receipts, cash reconciliation, and all manual work.
8. Ensure front desk forms and front office supplies are fully stocked for the next business day.
9. This position may require rotating coverage across the Behavioral Health, Dental and Medical front desk.
10. Identifies patient payer sources, verifies insurance eligibility, and benefits and determines co-pay and deductibles, PCP changes needed, SFS notifications, and communicates to patients and front desk prior to appointment.
11. Ensure scheduled appointments are scheduled within scheduling guidelines, PCP assignments are accurate, forwards HEDIS insurance print outs to medical staff and communicates any discrepancies to immediate supervisor and provider.
12. Completes administrative check offs by reviewing patient EHR, scheduling system (ECW) and identifies outstanding required administrative and clinical forms, administrative required documents such as native verifications, photo IDs, insurance cards and completion of SFS applications. Request paper chart from medical records as needed in accordance with medical records policy and guidelines.
13. Ensures data entry of payer source is accurate and updated to coincide with insurance verification, sequence patient's payer sources on the date of service in accordance to billing guidelines.
14. Scans all insurance verification to EHR, edits creation date, and double checks for readability and accuracy.
15. Ensure the medical schedules remain booked by calling patients from the "waiting list".
16. Other duties as assigned.

Qualifications:

Minimum Qualifications:

To successfully perform this job, the individual must be able to fulfill each essential duty and responsibility outlined in this position with performance standards. The qualifications listed below represent the necessary knowledge, skill and ability required.

1. High School Diploma or GED.
2. 2-3 years related experience and/or training, or equivalent combination of education and experience.
3. Current BLS and CPR certification through the American Heart Association

Preferred:

1. Experience serving a multinational, multicultural population.
2. FQHC background.
3. Familiarity with Community Health Clinics and/or Indian Health Clinics.
4. ECW EHR.

Special Conditions of Employment:

1. Annual background check as a condition of continued employment, ensuring ongoing eligibility and compliance with organizational standards.
2. Submit to for-cause drug screening when mandated by the organization to ensure a safe and compliant work environment.
3. Maintain up-to-date compliance with all mandatory annual requirements; licenses, certifications, physicals, TB exams, and any regulatory training as assigned by SDAIHC.

Knowledge, Skills, and Abilities:

1. Strong oral and written communication skills.
2. Exceptional time management skills
3. Highly organized and attention to detail.
4. Ability to maintain confidentiality and accurate records.
5. Strong interpersonal skills.
6. Ability to interact effectively with diverse individuals.
7. Capability to establish and maintain positive working relationships.
8. Proficiency in basic mathematical calculations is relevant to the role.
9. Dependable and highly trustworthy.
10. Proficiency in Microsoft office suite or similar software programs.

Physical and Mental Requirements:

1. The ability to lift and move up to 10 pounds and transition between location.
2. Ability to sit at a desk and work on a computer for extended periods.
3. Ability to stand, bend and reach for prolonged durations.
4. Strong mathematical, organizational skills, with the ability to work efficiently under pressure.
5. Capacity to multitask, comprehend, and follow instructions effectively.

Customer Service:

1. Actively upholds and promotes the Mission, Vision, and core values of SDAIHC.
2. Delivers exceptional customer service to both internal and external stakeholders.
3. Embodies SDAIHC's Customer Service Standards: Compassion, Attitude, Communication, Appearance, Sense of Ownership, and Teamwork.
4. Engage in on-going customer service training and development.
5. Strives to enhanced reputation as a leading service in every interaction.

Quality Management:

1. Supports organization by actively participating in quality improvement initiatives.
2. Adheres to all SDAIHC policies and procedures while proactively contributing to the implementation of new initiatives.
3. Actively participates in and supports the continuous quality improvement process as directed by clinic leadership.

Safety:

1. Ensures compliance with regulations and adherence to policies and procedures for maintaining a safe work environment.
2. Actively participates in infection prevention by following proper infection control measures during patient care interactions.
3. Maintains compliance with regulatory standards for physical space, equipment, and supplies.
4. Utilizes appropriate equipment and tools to uphold workplace safety.
5. Promptly reports unsafe working conditions.

Privacy/Compliance:

1. Ensures privacy and security of all patients, employees, and volunteer information granting access only on a need-to-know basis for business purposes.
2. Comply with all regulations regarding corporate integrity and security obligations. Reports unethical, fraudulent, or unlawful behavior or activity.
3. Upholds strict ethical standards.

Disclaimer:

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management's assignment of essential functions. It does not prescribe or restrict the tasks that may be assigned. This job description is subject to change at any time