Patient Resource Representative ( Remote)

Job Description :

VALLEY MEDICAL CENTER

JOB DESCRIPTION

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE : Patient Resource Representative

JOB OVERVIEW : The Patient Resource Representative position is responsible for scheduling, pre-registration, insurance verification, estimates, collecting payments over the phone, and inbound and outbound call handling for Primary and Specialty Clinics supported by the Patient Resource Center. This includes call handling for specialized access programs : Accountable Care Network Contracts Hotline Call Handling, MyChart Scheduling, and Outbound dialing for Referral Epic Workqueues.

DEPARTMNT : Patient Resource Center

WORK HOURS : As assigned

REPORTSTO : Supervisor, Patient Resource Center

PREREQUISITES :

High School Graduate or equivalent () preferred.

Minimum of 2 years of experience in a call center, or 1 year in a physician's office; with experience using multi-line phone systems, Electronic Medical Record systems, and working with several software programs at the same time.

Demonstrates basic skills in keyboarding (35 wpm)

Computer experience in a windows-based environment.

Excellent communication skills including verbal, written, and listening.

Excellent customer service skills.

Knowledge of medical terminology and abbreviations. Ability to spell and understand commonly used terms, preferred.

QUALIFICATIONS :

Ability to function effectively and interact positively with patients, peers and providers at all times.

Ability to access, analyze, apply and adhere to departmental protocols, policies and guidelines.

Ability to provide verbal and written instructions.

Demonstrates understanding and adherence to compliance standards.

Demonstrates excellent customer service skills throughout every interaction with patients, customers, and staff :

Ability to communicate effectively in verbal and written form.

Ability to actively listen to callers, analyze their needs and determine the appropriate action based on the caller's needs.

Ability to maintain a calm and professional demeanor during every interaction.

Ability to interact tactfully and show empathy.

Ability to communicate and work effectively with the physical and emotional development of all age groups.

Ability to analyze and solve complex problems that may require research and creative solutions with patient on the telephone line.

Ability to document per template requirements, gather pertinent information and enter data into computer while talking with callers.

Ability to utilize third party payer / insurance portals to identify insurance coverage and eligibility.

Ability to function effectively in an environment where it is necessary to perform several tasks simultaneously, and where interruptions are frequent

Ability to organize and prioritize work.

Ability to multitask while successfully utilizing varying computer tools and software packages, including :

Utilize multiple monitors in facilitation of workflow management.

Scanning and electronic faxing capabilities

Electronic Medical Records

Telephone software systems

Microsoft Office Programs

Ability to successfully navigate and utilize the Microsoft office suite programs.

Ability to work in a fast-paced environment while handling a high volume of inbound calls.

Ability to meet or exceed department performance standards for Quality, Accuracy, Volume and Pace.

Ability to speak, spell and utilize appropriate grammar and sentence structure.

UNIQUE PHYSICAL / MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS :

See Generic Job Description for Administrative Partner.

PERFORMANCE RESPONSIBILITIES :

Generic Job Functions : See Generic Job Description for Administrative Partner.

Essential Responsibilities and Competencies :

In-depth knowledge of VMC's mission, vision, and service offerings.

Demonstrates all expectations outlined in the VMC Caregiver Commitment throughout every interaction with patients, customers, and staff.

Delivers excellent customer service throughout each interaction :

Provides first call resolution, whenever possible.

Acknowledge if patient is upset and de-escalate using key words and providing options for resolution.

Identify and assess patients' needs to determine the best action for each patient. This is done through active listening and asking questions to determine the best path forward.

A knowledgeable resource for patient / customers that works to build confidence and trust in the VMC health care system.

Schedules appointments in Epic by following scheduling guidelines and utilizing tools and resources to accurately appoint patient.

Generates patient estimates and follows Point of Service (POS) Collection Guidelines to determine patient liability on or before time of service. Accepts payment on accounts with Patient Financial Responsibility (PFR) as well as any outstanding balances, documents information in HIS and provides a receipt for the amount paid.

Strives to meet patients access needs for timeliness and provider, whenever possible.

Applies VMC registration standards to ensure patient records are accurate and up to date.

Ensures accurate and complete insurance registration through the scheduling process, including verifies insurance eligibility or updates that may be needed.

Reviews registration work queue for incomplete work and resolves errors prior to patient arrival at the clinic.

Utilizes protocols to identify when clinical escalation is needed based on the symptoms that patients report when calling.

Takes accurate and complete messages for clinic providers, staff, and management.

Relays information in alignment with protocols and provides guidance in alignment with patient's needs.

Routes calls to appropriate clinics, support services, or community resource when needed.

Coordinates resources when needed for patients, such as interpreter services, transportation or connecting with other resources needed for our patient to be successful in obtaining the care they need.

Identifies, researches, and resolves patient questions and inquiries about their care and VMC.

Inbound call handling for our specialized access programs

Knowledge of contractual requirements for VMC's Accountable Care Network contracts and facilitates care in a way that meets contractual obligations.

Applies all workflows and protocols when scheduling for patients that call the

Completes scheduling patients for all departments the PRC supports.

Facilitates scheduling for all clinics not supported by the PRC.

Completes registration and transfer call to clinic staff to schedule.

Completes the MyChart Scheduling process for appointment requests and direct scheduled appointments.

Utilizes and applies protocols as outlined for MyChart scheduling

Meet defined targets for MyChart message turnaround time.

Outbound dialing for patient worklists

Utilizes patient worklists to identify patients that require outbound dialing.

Outbound dialing for referral work queues.

Utilizes referral work queue to identify patients that have an active / authorized referral in the system and reaches out to complete scheduling process.

Schedules per department protocols

Updates the referral in alignment with the defined workflow.

Receives, distributes, and responds to mail for work area.

Monitor office supplies and equipment, keeping person responsible for ordering updated.

Other duties as assigned.

Created : 1 / 25

Grade : OPEIUC

FLSA : NE

CC : 8318

#LI-Remote

Job Qualifications : PREREQUISITES :

1. High School Graduate or equivalent () preferred.

2. Minimum of 2 years of experience in a call center, or 1 year in a physician's office; with experience using multi-line phone systems, Electronic Medical Record systems, and working with several software programs at the same time.

3. Demonstrates basic skills in keyboarding (35 wpm)

4. Computer experience in a windows-based environment.

5. Excellent communication skills including verbal, written, and listening.

6. Excellent customer service skills.

7. Knowledge of medical terminology and abbreviations. Ability to spell and understand commonly used terms, preferred.

QUALIFICATIONS :

1. Ability to function effectively and interact positively with patients, peers and providers at all times.

2. Ability to access, analyze, apply and adhere to departmental protocols, policies and guidelines.

3. Ability to provide verbal and written instructions.

4. Demonstrates understanding and adherence to compliance standards.

5. Demonstrates excellent customer service skills throughout every interaction with patients, customers, and staff :

a. Ability to communicate effectively in verbal and written form.

b. Ability to actively listen to callers, analyze their needs and determine the appropriate action based on the caller's needs.

c. Ability to maintain a calm and professional demeanor during every interaction.

d. Ability to interact tactfully and show empathy.

e. Ability to communicate and work effectively with the physical and emotional development of all age groups.

6. Ability to analyze and solve complex problems that may require research and creative solutions with patient on the telephone line.

7. Ability to document per template requirements, gather pertinent information and enter data into computer while talking with callers.

8. Ability to utilize third party payer / insurance portals to identify insurance coverage and eligibility.

9. Ability to function effectively in an environment where it is necessary to perform several tasks simultaneously, and where interruptions are frequent

10. Ability to organize and prioritize work.

11. Ability to multitask while successfully utilizing varying computer tools and software packages, including :

a. Utilize multiple monitors in facilitation of workflow management.

b. Scanning and electronic faxing capabilities

c. Electronic Medical Records

d. Telephone software systems

e. Microsoft Office Programs

12. Ability to successfully navigate and utilize the Microsoft office suite programs.

13. Ability to work in a fast-paced environment while handling a high volume of inbound calls.

14. Ability to meet or exceed department performance standards for Quality, Accuracy, Volume and Pace.

15. Ability to speak, spell and utilize appropriate grammar and sentence structure.