Patient Relations Representative/Community Programs Specialist

1 week ago

Los Angeles, California, United States The County of Los Angeles Full time
Job Title: Patient Relations Representative/Community Programs Specialist

Join our team at The County of Los Angeles and make a difference in the lives of our community members. As a Patient Relations Representative/Community Programs Specialist, you will play a vital role in ensuring that our patients receive the highest level of 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.
  • Assist healthcare plan members in their interaction with medical care providers, administrative personnel, and third-party payers.
  • Serve as a liaison between patients, medical personnel, managed care plans, independent practice associations, insurance companies, case managers, utilization review personnel, and Medi-Cal eligibility workers.
  • Listen, identify, and recommend health options and services to help meet patients' needs.
  • Obtain demographic, financial, and insurance information.
  • Provide forms to patients and complete paperwork for requested services.
  • Research grievances with hospital administration, physicians, nurses, and other patient support staff; refer inquiries to appropriate departments or clinics for response.
  • Enroll, dis-enroll, or transfer members.
  • Schedule patient visits by determining the appropriate providers and programs for patients.
  • Ensure timely access to services by actively monitoring and coordinating multiple provider schedules and maintaining appointment templates for clinic providers.
  • Assign, coordinate, and review the work of lower-level personnel in the unit, ensuring proper work methods are followed.
  • Provide technical assistance and training.
  • Answer and document incoming calls from patients or providers or greet walk-in members who have concerns surrounding medical care issues.
  • Access patient information from various medical plan systems and files for reference purposes and use computer systems to track and document all complaints and outcomes.
  • Re-verify eligibility in the month of the appointment to financially clear patients for appointments, conduct patient outreach by phone and/or mail, explain coverage options to patients, refer patients to member services as needed, and cancel appointments.
  • Check-in patients for appointments to explain payment options and obtain signatures and collect and keep 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.
  • Apply various rules and regulations of Medicare, Medicaid, Managed Care, and commercial payers regarding referrals, authorizations, and certifications.
  • Perform general office duties, such as answering multiple lines, making appointment reminders, copying, filing, scanning, and faxing.
  • Initiate and/or process applications for various 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.
  • Prepare daily, weekly, and monthly patient service and activity reports for management's review.
Requirements:
  • Option I: Two (2) years of experience in the service of the County of Los Angeles as a Patient Resources Worker.
  • Option II: 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.
Benefits:
  • 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 II - Light: 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.
How to Apply:

Please submit your application online through our website. Make sure to include all required documents and information. We look forward to reviewing your application.

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