Patient Service Representative (Clerk III)

About the role

The Patient Service Representative (Clerk III) plays a crucial role in ensuring that Medicare beneficiaries are informed, updated, and assisted when necessary. This position is vital in responding to questions, triaging calls, performing case intake, staffing the Medicare Helpline, and maintaining the quality of the QIO process.

Responsibilities

• Informs Medicare beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program.
• Affords neutral liaison roles for beneficiaries, their families, or their representatives.
• Communicates with physicians, facilities, and other healthcare and community organizations as needed.
• Ensures the accuracy and timeliness of the review process.
• Maintains positive relationships with external and internal customers.
• Prepares and manages correspondence and mailings.
• Processes and maintains medical records.
• Tracks all telephone calls, essential conversations, and letters mailed to beneficiaries and providers using an electronic web-based application.
• Enters data into software applications timely and accurately.
• Participates in the continuous improvement process to identify quality issues and recommend solutions.
• Assists in preparing for ISO audits.
• Protects the confidentiality of beneficiary information through compliance with HIPAA and HITECH.
• Attends annual security awareness, rules of conduct, and conflict of interest training.
• Performs other duties as assigned.

Qualifications

• Experience as a call center representative or patient service representative.
• Considerable knowledge of business English, medical terminology, spelling, punctuation, vocabulary, filing, and general office methods.
• Working knowledge of the healthcare provider business and all the components of medical record documentation.
• Knowledge of Centers for Medicare & Medicaid Services (CMS), Medicare, and the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) programs.
• Associate degree in business education or health information management and two years of experience related to a majority of the primary duties of the job, OR Graduation from a secretarial school and three years of experience related to a majority of the primary duties of the job, OR High school diploma or General Education Development (GED) with four years of experience related to most of the job's primary duties.
• Two years of experience and skill in Microsoft Word and Microsoft Excel spreadsheet programs.
• Excellent oral and written communication skills.
• Excellent interpersonal and problem-solving skills.
• Essential knowledge of medical terminology and components of medical record documentation.
• Working knowledge of CMS, Medicare, and the QIO programs.
• Ability to exercise sound judgment.
• Ability to organize and coordinate multiple simultaneous tasks in a team environment.
• Ability to maintain effective working relationships and communications with providers and stakeholders.
• Ability to collect data and distinguish relevant material.
• Ability to maintain objectivity.
• Ability to work independently.
• Ability to give and receive feedback.

Skills

• Excellent oral and written communication skills.
• Excellent interpersonal and problem-solving skills.
• Working knowledge of CMS, Medicare, and the QIO programs.
• Ability to exercise sound judgment.
• Ability to organize and coordinate multiple simultaneous tasks in a team environment.
• Ability to maintain effective working relationships and communications with providers and stakeholders.
• Ability to collect data and distinguish relevant material.
• Ability to maintain objectivity.
• Ability to work independently.
• Ability to give and receive feedback.

Benefits

This is a fully on-site position with flexible scheduling that includes weekends and holiday shifts. The position is exempt from overtime pay under the Fair Labor Standards Act (FLSA).

Pay

The salary range for this position is $45,000 - $55,000 annually, depending on experience and qualifications. Commence offers a competitive compensation package, including health insurance, retirement plans, and paid time off.

Schedule

Candidates must be available for a variety of shifts, including weekends and holidays. The schedule will vary based on the needs of the organization.

Work Environment/Physical Demands

The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This is a fully onsite position. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

Equal Employment Opportunity

Commence is an equal employment opportunity employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law. Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or hr@commence.ai. Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.