Patient Service Representative (Clerk III) | Medicare

We need to output HTML fragment with sections: headings

for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Use

• for any list of duties/requirements/benefits, and

  for prose. Do NOT repeat job title as heading. Do NOT put Job ID/requisition numbers as headings. Remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning, duplicated lines, application instructions. Preserve all substantive info. Include a section only when posting has real, specific content for it. Avoid headings with filler like "commensurate with experience", "not specified", etc. Do not create Pay/Schedule/Benefits unless posting actually states them. We have job description: "Job Type Full-time Description At Commence, we’re the start of a new age of data-centric transformation..." That's about the role. Then "Requirements" section with many bullet-like sentences. Then "Qualifications" with many bullet-like sentences. Then "Organizational 'Fit' Considerations:" maybe part of Qualifications? Then "SCA Coverage" details about wage determination, maybe not needed? It's legal/boilerplate? Might be considered not needed? It's about wage determination, but not exactly EEO. Might be considered legal boilerplate; but it's about SCA coverage, which is relevant to wage? The posting also includes "Work Environment/Physical Demands" and then EEO statements. Then "Salary Description $20.13 + $5.09HW". That's pay info. We need to decide which sections to include: About the role (description), Responsibilities (maybe from Requirements?), Requirements (maybe the list of duties?), Qualifications, Skills (maybe from qualifications?), Pay (salary), Schedule (maybe from "Schedules will vary and include weekends and holiday shifts.") Benefits? Not mentioned. So we should not include Benefits. We must not include filler like "commensurate with experience". Not present. We need to extract substantive content. Let's parse: Job Type Full-time Description: "At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care." That's about the role/company. Then "Requirements" heading: Actually the posting says "Requirements The Patient Service Representative (Clerk III) ensures that Medicare beneficiaries are informed, updated, and assisted when necessary. This position responds to questions from beneficiaries, triages beneficiary calls, performs case intake, and staffs the Medicare Helpline as required. 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 Quality Improvement Organization (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." That's a list of duties/responsibilities. Could be considered Responsibilities section. Then "Qualifications" heading: "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.Must possess excellent oral and written communication skills. Must be attentive to detail. Familiarity with database software programs (e.g., Microsoft Office). Must possess excellent interpersonal and problem-solving skills. Must possess 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. Organizational "Fit" Considerations: Works well with other patient service representatives and team members. Establishes and maintains good professional relationships with people on all levels within Company and physicians and others outside of Company. Schedules will vary and include weekends and holiday shifts." Then after that: "SCA Coverage Company is a federal contractor under the McNamara-O'Hara Service Contract Act (SCA). ..." That's legal boilerplate; we should remove. Then "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." Then EEO statements: "Commence is an equal employment opportunity for employer...." Remove. Then "Salary Description $20.13 + $5.09HW" Thus sections: About the role (description), Responsibilities (the list under Requirements), Qualifications (the list under Qualifications), Skills (maybe we can extract skills from qualifications? But we already have Qualifications; maybe we can combine? The instruction: Use headings for section headings e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. It says we should use those headings when appropriate. We have content for About the role, Responsibilities, Qualifications, Pay, Schedule. We also have maybe Requirements? The posting had a "Requirements" heading but its content is duties/responsibilities. Could treat that as Responsibilities. The Qualifications heading is separate. Could also have a Skills section if we want to pull out skills like "excellent oral and written communication skills", "attentive to detail", etc. But we already have those in Qualifications. Might be redundant. Better to follow the posting's headings: Requirements (duties) and Qualifications (skills/education). But the instruction list includes both Requirements and Qualifications as possible headings. So we can use both. Thus sections: - About the role: description paragraph. - Responsibilities: list of duties (from Requirements). - Qualifications: list of qualifications (education, experience, skills). - Pay: salary description. - Schedule: note about schedules varying and include weekends and holiday shifts. We should not include Benefits (none). Also we should not include Work Environment/Physical Demands? That could be considered part of About the role? But it's substantive. Could we include a section like "Work Environment"? Not in the list of allowed headings; but we could incorporate into About the role or Responsibilities? The instruction says use those headings for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't forbid other headings, but says "Use

  for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." It implies we should use those headings for sections; we could also use other headings if needed? Safer to stick to those. Work environment could be placed under About the role or Responsibilities? Probably better to include a short paragraph under About the role? But the description already is about company mission. Work environment is separate. Could we add a section "Work Environment"? Not in the list but maybe allowed as e.g. The instruction says "Use

  for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." The "e.g." suggests those are examples, not exhaustive. However, to be safe, we could incorporate work environment into About the role or Responsibilities? Might be okay to add a Work Environment section as it's substantive. But the instruction says "Prefer a few substantive sections over many thin ones." Adding a Work Environment section would be another section. Might be okay. But we also have SCA Coverage and EEO which we must remove. Thus final HTML:

  About the role

  At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

  Responsibilities

  • The Patient Service Representative (Clerk III) ensures that Medicare beneficiaries are informed, updated, and assisted when necessary.
  • Responds to questions from beneficiaries, triages beneficiary calls, performs case intake, and staffs the Medicare Helpline as required.
  • 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 Quality Improvement Organization (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