Patient Service Representative (Clerk III)

About the role

The Patient Service Representative (Clerk III) plays a crucial role in ensuring Medicare beneficiaries are informed, updated, and assisted. This position responds to questions, trims calls, performs case intake, and staffs the Medicare Helpline as needed. They also inform beneficiaries and other interested parties of their rights and responsibilities, assist with the review process, act as a neutral liaison, and communicate the QIO’s activities and responsibilities.

Responsibilities

• Informs Medicare beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program.
• Assists with the review process to maintain required timeliness and accuracy as stipulated by the contract and the QIO manual.
• Acts as a neutral liaison for beneficiaries, their families, or their representatives.
• Informs Medicare beneficiaries, healthcare providers, and other partners of the activities and responsibilities of the QIO.
• Develops and maintains positive relationships with external and internal customers.
• Prepares correspondence to physicians, facilities, and other healthcare and community organizations as needed.
• Ascertains the most current and correct contact information, maintains accurate mailing lists, and coordinates 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 recommends solutions.
• Assists in preparation for International Standardization Organization (ISO) audits.
• Protects the confidentiality of beneficiary information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (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.
• 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.

Benefits

Commence is an equal employment opportunity for 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.