Patient Services Representative

Job Summary

Primary responsibilities involve providing registration and eligibility services to obtain and process demographic and insurance information for alternate resources, Purchased Referred Care services, Marketplace Sponsorship Program, and private/commercial insurance. The incumbent is responsible for scheduling, rescheduling and maintaining the clinic schedule of their assigned area. This position uses the patient schedule system to check-in scheduled and un-scheduled visits within the Oyate Health Center (OHC). The position requires the incumbent to work on a rotating basis.

Essential Functions

• Answers telephone and greets visitors; provides information and assistance; schedules appointments; and resolves problems.
• Gathers patient demographic information, updates patient information, and registers patients in the electronic system; determines eligibility for services; and obtains documentation of Indian blood or other documentation of Tribal membership.
• Obtains and verifies the health records and RPMS Patient Registration information including Medicaid, Medicare, and private/commercial insurance eligibility prior to clinic visits.
• Interviews patient to gather information and establishes a new health record and/or contacts Health Information Management to re-establishes inactive health records if necessary...
• Assists patients in completing new or updated forms for the RPMS Patient Registration System.
• Identifies and obtains pre-authorization for the patient when needed.
• Prepares documents and obtains patient's and/or guardian's signature on required forms as needed, files or routes documents to others appropriately.
• Ensures that minor consent forms are prepared, completed, and filed in patient medical chart.
• Schedules appointments and follow up appointments when necessary.
• Calls patients in advance of scheduled appointment to confirm appointment and collect necessary data to verify insurance eligibility.
• Identifies and obtains pre-authorization for the patient when needed.
• Maintains, key-enters, updates, and verifies all Alternate Resources data necessary for patient registration and for accurate billing, and makes corrections as necessary to improve the Patient Registration System.
• Assists with orientation of new personnel and provides orientation specific to appointments desk processes as needed.
• Works in coordination with Benefits Coordinators to establish patient eligibility for the Marketplace Sponsorship Program. Completes necessary tracking forms and turn in weekly or as requested.
• Provides reports in accordance with established schedule and format as requested.
• Maintains adequate supply of required forms/documents.
• Participates on performance improvement teams and other committees as assigned.
• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
• Performs related duties.

Requirements

• Participates in Core Connections training and applies GPTLHB Core Connections concepts and practices in their work.
• Knowledge of HIPAA.
• Knowledge of eligibility requirements and acceptable documentation.
• Knowledge of patient registration principles.
• Knowledge of medical terminology.
• Knowledge of current state laws concerning vital statistic records and birth/death certificates.
• Knowledge of modern office practices and procedures.
• Knowledge of the correct and effective use of English, including grammar, spelling, and punctuation.
• Knowledge of assigned department's policies and procedures.
• Knowledge of computers and job-related software programs.
• Knowledge of customer service principles.
• Ability to work with personal computer and utilize a variety of software applications, including database and office software systems.
• Ability to communicate clearly and effectively, both orally and in writing, using tact and sensitivity.
• Ability to organize the multiple demands of the job.
• Skill in prioritizing and organizing work, and maintenance of files and records.
• Skill in the provision of customer services.
• Skill in the use of such office equipment as a computer, scanner, fax machine, and copier.
• Skill in oral and written communication.

Education/Experience/Certificates/Credentials

• High school diploma or equivalent.
• One (1) year of administrative office support experience sufficient to understand the major duties of the position, and to be able to answer questions and resolve problems. Experience in a clinic setting is preferred.
• Must successfully pass a criminal and background check, and a pre-employment drug screen.

The GPTLHB is a tribal organization which follows tribal preference laws. It is our policy to give preference to qualified Indian/Tribal candidates over qualified non-native candidates in hiring decisions, if all other qualifications are equal. Employment is contingent upon the outcome of all required criminal background checks.

Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.