Patient Service Representative (Clerk III) | Medicare

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 processes for program and patient health. We combine quality data‑driven solutions, 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 and focus on efficiencies that transform the lives of those we serve.

Responsibilities

• 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 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 components of medical record documentation.
• Knowledge of 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 related experience, or graduation from a secretarial school and three years of related experience, or high school diploma/GED with four years of related experience.
• Two years of experience and skill in Microsoft Word and Microsoft Excel.
• Excellent oral and written communication skills.
• Attention to detail.
• Familiarity with database software programs (e.g., Microsoft Office).
• Excellent interpersonal and problem‑solving skills.
• Essential knowledge of medical terminology and components of medical record documentation.
• 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

• Works well with other patient service representatives and team members.
• Establishes and maintains good professional relationships with people at all levels within the company and with physicians and others outside the company.

Schedule

Schedules will vary and include weekends and holiday shifts.

Work Environment and Physical Demands

This is a fully onsite position. Candidates must be able to sit, read, work on a computer, and watch a screen for extended periods. Occasionally required to stand, walk, use hands and fingers, kneel, or crouch. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SCA Coverage

Commence is a federal contractor under the McNamara‑O'Hara Service Contract Act (SCA). The position of Patient Service Representative is classified as a “service position” mapped to Occupation Code 01113 – General Clerk III in the current wage determination. Covered employers must pay prevailing wages and benefits as determined by the U.S. Department of Labor. Wage determinations and employee rights notices are posted in break rooms or other locations where labor law posters are displayed.