Patient Services Representative

Job Summary

Primary responsibilities involve providing registration and eligibility services to obtain and process demographic and insurance information for alternate resources, Purchased Referred Care services, Marketplace Sponsorship Program, and private/commercial insurance. The incumbent is responsible for scheduling, rescheduling and maintaining the clinic schedule of their assigned area. This position uses the patient schedule system to check-in scheduled and un-scheduled visits within the Oyate Health Center (OHC). The position requires the incumbent to work on a rotating basis.

Essential Functions

• Answers telephone and greets visitors; provides information and assistance; schedules appointments; and resolves problems.
• Gathers patient demographic information, updates patient information, and registers patients in the electronic system; determines eligibility for services; and obtains documentation of Indian blood or other documentation of Tribal membership.
• Obtains and verifies the health records and RPMS Patient Registration information including Medicaid, Medicare, and private/commercial insurance eligibility prior to clinic visits.
• Interviews patient to gather information and establishes a new health record and/or contacts Health Information Management to re-establishes inactive health records if necessary...
• Assists patients in completing new or updated forms for the RPMS Patient Registration System.
• Identifies and obtains pre-authorization for the patient when needed.
• Prepares documents and obtains patient’s and/or guardian’s signature on required forms as needed, files or routes documents to others appropriately.
• Ensures that minor consent forms are prepared, completed, and filed in patient medical chart.
• Schedule appointments and follow up appointments when necessary.
• Call patients in advance of scheduled appointment to confirm appointment and collect necessary data to verify insurance eligibility.
• Identifies and obtains pre-authorization for the patient when needed.
• Maintains, key-enters, updates, and verifies all Alternate Resources data necessary for patient registration and for accurate billing, and makes corrections as necessary to improve the Patient Registration System.
• Assists with orientation of new personnel and provides orientation specific to appointments desk processes as needed.
• Works in coordination with Benefits Coordinators to establish patient eligibility for the Marketplace Sponsorship Program. Completes necessary tracking forms and turn in weekly or as requested.
• Provides reports in accordance with established schedule and format as requested.
• Maintains adequate supply of required forms/documents.
• Participates on performance improvement teams and other committees as assigned.
• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
• Performs related duties.

Professional Behavior

• Effectively plan, organize workload and schedule time to meet the demands of the position.
• Work in a cooperative and professional manner with OHC and GPTLHB staff.
• Treat Great Plains tribes and collaborators with dignity and respect.
• Utilize effective verbal and written communication skills.
• Advance personal educational development by attending training sessions and seminars as appropriate.
• Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and guests.
• Foster a work environment of wellness, courtesy, friendliness, helpfulness and respect.
• Relate well and work collaboratively with coworkers and all levels of staff in a professional manner.
• Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities.
• Maintain and ensure organizational privacy and confidentiality.
• Handle crisis and tolerate stress professionally.
• Be self-directed and take proactive initiative to assist others.
• Resolve issues with other departments and coworkers without direct supervision if needed.
• Exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment.
• Promote an alcohol, tobacco and drug-free lifestyle.
• Embrace modes of appearance and attire that reflect a professional presence.
• Adhere to GPTLHB policies and procedures.
• Other duties as assigned by the Supervisor.

Requirements

• Participates in Core Connections training and applies GPTLHB Core Connections concepts and practices in their work.
• Knowledge of HIPAA.
• Knowledge of eligibility requirements and acceptable documentation.
• Knowledge of patient registration principles.
• Knowledge of medical terminology.
• Knowledge of current state laws concerning vital statistic records and birth/death certificates.
• Knowledge of modern office practices and procedures.
• Knowledge of the correct and effective use of English, including grammar, spelling, and punctuation.
• Knowledge of assigned department’s policies and procedures.
• Knowledge of computers and job-related software programs.
• Knowledge of customer service principles.
• Ability to work with personal computer and utilize a variety of software applications, including database and office software systems.
• Ability to communicate clearly and effectively, both orally and in writing, using tact and sensitivity.
• Ability to organize the multiple demands of the job.
• Skill in prioritizing and organizing work, and maintenance of files and records.
• Skill in the provision of customer services.
• Skill in the use of such office equipment as a computer, scanner, fax machine, and copier.
• Skill in oral and written communication.

Supervisory Controls

The supervisor assigns work in terms of very general instructions. The supervisor spot-checks completed work for compliance with procedures and the nature and propriety of the final results. Work is reviewed through reports, and observation of interactions with co-workers and OHC patients.

Guidelines

Guidelines include GPTLHB, OHC, and department policies and procedures. These guidelines are generally clear and specific, and deviations must be authorized by the supervisor.

Complexity/Scope of Work

This position consists of related clerical duties. The purpose of this position is to provide administrative support to the assigned area. Successful performance contributes to the efficiency and effectiveness of the assigned area’s operations.

Contacts

Contacts are typically with providers, other employees, and patients. Contacts are typically to give and exchange information and provide assistance.

Work Environment/Physical Demands

The work is typically performed while sitting at a desk or table or while intermittently sitting, standing, stooping, or walking; use hands and fingers to manipulate, handle, or feel; and talk or hear. The employee occasionally lifts light objects and distinguishes between shades of color. The work is typically performed in a clinic setting which requires normal safety precaution for infection control and environmental safety measures. The noise level in the work environment is usually moderate.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory and Management Responsibility

This position has no formally assigned supervisory responsibility or authority. The employee is responsible only for the performance of their own assigned work. They may be asked to train new employees in the fundamentals of the jobs or to participate in cross-training of other employees in the department, but such assignments do not include the on-going authority to assign and review work of other employees or to recommend or take corrective action with regard to other employees' performance.

Education/Experience/Certificates/Credentials

• High school diploma or equivalent.
• One (1) year of administrative office support experience sufficient to understand the major duties of the position, and to be able to answer questions and resolve problems. Experience in a clinic setting is preferred.
• Must successfully pass a criminal and background check, and a pre-employment drug screen.

The GPTLHB is a tribal organization which follows tribal preference laws. It is our policy to give preference to qualified Indian/Tribal candidates over qualified non-native candidates in hiring decisions, if all other qualifications are equal.

Employment is contingent upon the outcome of all required criminal background checks.