Patient Services Representative

Future SDAIHC - San Diego American Indian Health Center

Summary: This position serves as the Behavioral Health Patient Services Representative for the San Diego American Indian Health Center Medical Department. This position ensures that the highest level of patient care is rendered to patients by greeting, answering incoming calls, registration, appointment scheduling, insurance verification and explains financial obligations, updates Eclinical Works(ECW),and Electronic Health Records (EHR) with patient’s updates, required administrative forms and documents and performs other various clerical duties.

Essential Duties and Responsibilities:

1. Greets patients in a courteous and respectful manner and maintains receptionist area and patient lobby clean, safe and comfortable for patients, visitors.
2. Schedule patient appointments including calling patients for reminders the day before, and rescheduling appointments if necessary.
3. Verifies patient information by interviewing patient; reviewing and/or recording medical history; confirming purpose of visit or treatment.
4. Completes records as assigned by providers.  Generates revenues by recording billing information of services rendered; completing insurance forms; responding to insurance and other third-party inquiries.
5. Maintains patient confidentiality and protects operations by keeping patient care information confidential.
6. Assists patients in completing BH client self-assessments and get release of information forms signed.
7. Ability to handle many phone calls regarding client medication concerns; must be calm and able to handle upset clients in a respectful and factual manner, while also informing PNPs.
8. Obtain insurance “prior authorizations” so patients can be seen and/or medications prescribed.
9. Inventory supplies and materials
10. Data entry to maintain office and patient records.
11. Ability to demonstrate superior customer service.
12. Interact with staff in a supportive manner to keep the workflow going and to keep the department safe and clean.

 13. On occasion assist client in office or call in having a crisis and will need to know how to respond to help the client keep calm and to keep the department safe.

 14.  Ensures verification and data entry of updated demographics and insurance information is completed, clinical and administrative forms and documents are completed and                    scanned, screens and process applications for available medical programs such as CHDP/EWW/FPACT/SFS, clinical codes are entered correctly during patient check-in. 

15. Answers incoming calls and ensures new patient appointments, appointment cancellations and rescheduling of appointments are completed in a timely manner.

16. Ensures voicemail messages and returns phone calls are completed promptly per front desk process and guidelines.

17. Maintains schedules updated with current status throughout the business day, assures no-shows are coded and patients are checked-in and out in a timely manner in accordance to medical department guidelines and process.

18. Ensures appointment report is scanned to fiscal by 10:00 am the next business day.

19. Identifies patient payer sources, verifies insurance eligibility and benefits and determines co-pays and deductibles, PCP changes needed, SFS notifications, and communicates to patients and front desk prior to appointment.

20. Ensures scheduled appointments are scheduled within scheduling guidelines, , forwards HEDIS insurance print outs to Provider and communicates any discrepancies to immediate supervisor and provider.

21. Completes administrative check offs by reviewing patient EHR, scheduling system and identifies outstanding required administrative and clinical forms, administrative required documents such as native verifications, photo IDs, insurance cards and completion of SFS applications. Request paper chart from medical records as needed in accordance to medical records policy and guidelines.

22. Ensures data entry of payer source is accurate and updated to coincide with insurance verification, sequence patient’s payer sources on the date of service in accordance to billing guidelines.

23. Scans all insurance verification to EHR, edits creation date, and double checks for readability and accuracy.

24. Confirm appointments and documents appointment status in appointment “info box”.

25. Provide the front desk with the next day’s medical printed schedules prior to the end of business day.

26. Ensures the medical schedules remain booked by calling patients from the “waiting list”.

Required Qualifications: To perform this job successfully, an individual must be able to perform each essential duty and responsibilities set forth in this position performance standard policy. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:  High School Diploma or GED. Minimum of year working in a Behavioral Health setting. 

Additional requirements as listed below:

• Commitment to working in the Native American and surrounding community.
• Commitment to community health care.
• Familiarity with community health clinics and/or Indian Health Clinics preferred.

Language Skills:  Able to read and comprehend at a 12th grade level; able to communicate professionally in person and in writing.

Mathematical Skills:  Must possess basic mathematical skills to complete the responsibilities of the position and includes ability to add, subtract, multiply, and divide. In. Must be familiar with common fractions, decimals compute rate, ratio, prepare and interpret graphs.

Reasoning Ability:  Able to apply common sense understanding to carry out instructions furnished in written or oral form. Apply logic and reasoning to identify strengths and weaknesses of alternative approaches, solutions or conclusions in order to effectively resolve problems.

Computer Skills:  To perform this job successfully, an individual should have knowledge of accounting software, database software, internet software, Microsoft Office applications.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without accommodation.

• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently lift, carry, push, pull objects, including bodily motion.
• Moving on foot to accomplish tasks, particularly from one work site to another.
• Substantial movements of the wrists, hands and or/fingers to operate computer and other office equipment such as telephones and printers.
• Occasionally ascend/descend stairs to access different departments.

 Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Acknowledgement:  The San Diego American Indian Health Center is an Equal Opportunity Employer.  We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, ancestry, age, marital status, physical or mental disability, or any other protected class, political affiliation, or belief.

Preference in filling vacancies is given to qualified American Indian candidates in accordance with the Indian Preference Act of 1934, (Title 25, USC Section 472).