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Patient Relations Representative/Community Programs Specialist

2 months ago


Los Angeles, California, United States The County of Los Angeles Full time
About the Role

The County of Los Angeles is seeking a highly skilled Patient Relations Representative/Community Programs Specialist to join our team. As a key member of our healthcare team, you will play a vital role in ensuring that patients receive the best possible care and support.

Key Responsibilities
  • Assess and resolve complex patient issues related to primary care linkage, eligibility, billing for services, and managed care plan assignment.
  • Research errors and patient issues, and take proper action to satisfy those needs by responding to member questions.
  • Assist healthcare plan members in their interaction with medical care providers, administrative personnel, and third-party payers.
  • Serve as liaison between patients, medical personnel, managed care plans, independent practice associations, insurance companies, case managers, utilization review personnel, and Medi-Cal eligibility workers.
  • Listens, identifies, and recommends health options and services to help meet patients' needs.
  • Obtains demographic, financial, and insurance information.
  • Provides forms to patients and completes paperwork for requested services.
  • Research grievances with hospital administration, physicians, nurses, and other patient support staff; refers inquiries to appropriate department or clinic for response.
  • Enrolls, dis-enrolls, or transfers members.
  • Schedules patient visits by determining the appropriate providers and programs for patients.
  • Ensures timely access to services by actively monitoring and coordinating multiple provider schedules and maintaining appointment templates for clinic providers.
  • Assigns, coordinates, and reviews the work of lower-level personnel in the unit, ensuring proper work methods are followed.
  • Provides technical assistance and training.
  • Answers and documents incoming calls from patients or providers or greets walk-in members who have concerns surrounding medical care issues.
  • Accesses patient information from a variety of medical plan systems and files for reference purposes and uses computer systems to track and document all complaints and outcomes.
  • Re-verifies eligibility in the month of the appointment to financially clear patients for appointments, conducts patient outreach by phone and/or mail, explains coverage options to patients, refers the patient to member services as needed, and cancels appointments.
  • Checks-in patient for appointment to explain payment options and obtains signatures and collects and keeps records of insurance and patient identification.
  • Manage/build provider and clinic templates -Design Change Worksheets (specialized work) working alongside clinicians and Cerner to complete the request as assigned.
  • Applies various rules and regulations of Medicare, Medicaid, Managed Care, and commercial payers regarding referrals, authorizations, and certifications.
  • Performs general office duties, such as answering multiple lines, making appointment reminders, copying, filing, scanning, and faxing.
  • Initiates and/or processes applications for a variety of reduced no-cost/low-cost programs, such as Ability to Pay, Ryan White/Casewatch, Family Planning Access Care Treatment (Family PACT) program, Uniform Method of Determining Ability to Pay, and Hospital Presumptive Eligibility.
  • Prepares daily, weekly, and monthly patient service and activity reports for management's review.
Requirements
  • Two (2) years of experience in the service of the County of Los Angeles as a Patient Resources Worker.
  • Three (3) years of experience in a healthcare setting at the level of Patient Resources Worker which includes identifying patients' financial resources to pay for medical and/or mental health care and services; and assists patients in making assignments for medical benefits and completes standardized billing forms based upon data acquired with responsibility for performing patient access related work in Emergency Department/Urgent Care registration or other walk-in registration, admitting, financial screening and eligibility verification, and scheduling areas.
License

A valid California Class C Driver License or the ability to utilize an alternative method of transportation when needed to carry out job-related essential functions.

Physical Class

This class includes administrative and clerical positions requiring light physical effort that may include occasional light lifting to a 10-pound limit and some bending, stooping, or squatting. Considerable ambulation may be involved.