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Patient Service Representative

2 months ago


Los Angeles, United States Med National Staffing Inc. Full time
Job DescriptionJob Description

Job Overview: The Patient Service Rep provides clerical and data entry support for Molina Members requiring hospitalization or utilization review for healthcare services. This role ensures the delivery of high-quality, cost-effective healthcare services in compliance with State and Federal requirements. The Patient Service Rep is a key contributor to optimal member outcomes.

Essential Functions:

  • Provide computer entries for authorization requests and provider inquiries received via phone, mail, or fax, including verifying member eligibility and benefits, determining provider contracting status, diagnosis and treatment requests, and assigning billing codes (ICD-9/ICD-10, CPT/HCPC).
  • Determine COB status and verify inpatient hospital census, including admissions and discharges.
  • Perform required actions using appropriate databases in accordance with established protocols.
  • Respond to service authorization requests submitted to CAM through phone, fax, and mail within Molina’s operational timeframes.
  • Collaborate interdepartmentally to enhance continuity of care, including working with Behavioral Health and Long Term Care teams.
  • Contact physician offices per department guidelines to request missing information for authorization requests or additional data as needed.
  • Provide excellent customer service to internal and external customers.
  • Meet quality standards, including inter-rater reliability (IRR) testing and quality review audit scores.
  • Notify Care Access and Monitoring Nurses and Case Managers of hospital admissions and member status changes.
  • Maintain confidentiality and comply with HIPAA regulations.
  • Participate actively in Care Access and Monitoring meetings and adhere to Molina’s attendance and workplace safety standards.

Knowledge, Skills, and Abilities:

  • Strong communication, problem-solving, and interpersonal skills.
  • Knowledge of medical terminology and abbreviations.
  • Analytical thinking with the ability to solve problems effectively.
  • High regard for confidentiality and the ability to work in a fast-paced environment.
  • Proficiency in Microsoft Office and accurate data entry at a minimum of 40 WPM.
  • Ability to work independently and as part of a team.

Required Education:

  • High School Diploma or GED.

Required Experience:

  • 2-4 years of experience in a Utilization Review Department in a Managed Care Environment.
  • Previous experience in hospital or healthcare clerical roles, audits, or billing.
  • Familiarity with medical terminology.
Company DescriptionSince our founding in 2005, MedNational has grown into a full-service Healthcare Human Capital Solutions Organization. We are proud to deliver our traditional permanent placement and contract service opportunities.

MedNational professionals experience career opportunities in the following niche areas:
• Hospitals
• Physicians’ offices
• Nursing care facilities
• Home healthcare services
• Government agencies
• Educational services
• Support services
• Schools
• Community centers
• Urgent care centers
• Offices

Today, we conduct business in all corners of North America, and continue to be laser focused on our mission. We deliver our clients with career oriented and quality-focused health care professionals while enriching the lives of these professionals during their period of transition to a new challenge and opportunity.Company DescriptionSince our founding in 2005, MedNational has grown into a full-service Healthcare Human Capital Solutions Organization. We are proud to deliver our traditional permanent placement and contract service opportunities.\r
\r
MedNational professionals experience career opportunities in the following niche areas:\r
• Hospitals\r
• Physicians’ offices\r
• Nursing care facilities\r
• Home healthcare services\r
• Government agencies\r
• Educational services\r
• Support services\r
• Schools\r
• Community centers\r
• Urgent care centers\r
• Offices\r
\r
Today, we conduct business in all corners of North America, and continue to be laser focused on our mission. We deliver our clients with career oriented and quality-focused health care professionals while enriching the lives of these professionals during their period of transition to a new challenge and opportunity.