Patient Services Rep - Full-time

This position serves as the Patient Services Representative for SDAIHC. The role is integral to providing outstanding patient care by warmly welcoming patients, efficiently managing incoming calls, overseeing registration and appointment scheduling. Additionally, the representative ensures accurate insurance verification and clearly communicates financial responsibilities to patients. The position is also responsible for updating patient information, required administrative forms, and documentation in both the eCW and Electronic Health Records (EHR). In addition to these core duties, this role includes performing a variety of clerical tasks to support the smooth operation of the medical department.

 

The PSR plays a critical role in ensuring timely patient access to care by maintaining a call abandonment rate below 7%, scheduling appointments accurately within department protocols, and verifying complete and correct patient demographic information at every encounter. In addition to these core duties, this role includes performing a variety of clerical tasks to support the smooth operation of the medical department.

 

Must be able to demonstrate knowledge and skills necessary to perform all job-related activities as outlined below.

 

Essential Duties and Responsibilities:

 

Primary Functions:

 

1. Warmly greet patients in a courteous and respectful manner while maintaining a clean, safe and comfortable reception area and patient lobby.
2. Process new patient registration in accordance with billing and medical records guidelines.

Primary Functions: continue

 

1. Ensures accurate verification and data entry of patient demographics insurance information, and scanning required clinical and a and administrative forms, screening and processing of applications for medical programs CHDP/EWW/FPACT/SFS/RHAP) and correct entry of clinical codes during check in. 
2. Gather patient information for walk in triage by completing a triage slip (including patient’s name, HRN #, DOB, chief complaint, payer source), verify insurance eligibility and benefits, and collects necessary administrative and clinical forms following medical department procedures.
3. Collects payments for outstanding balances, co-pays, and services provided at the time of service and provides patients and the fiscal department with accurate receipts in accordance with fiscal guidelines.
4. Makes next patient appointments in accordance with medical scheduling templates and scheduling guidelines established by the Medical Director.
5. Answers incoming calls and ensure new patient appointments, appointment cancellations and rescheduling of appointments are completed in a timely manner. Ensure voicemail messages and return phone calls are completed promptly by front desk process and guidelines.
6. Maintains schedules updated with status throughout the business day, assures no-shows are coded and patients are checked-in and out in a timely manner in accordance with medical department guidelines and process.
7. Performs “end of day” duties:
8. Double checks receipts, cash reconciliation, and all manual work.
9. Ensure front desk forms and front office supplies are fully stocked for the next business day.
10. This position may require rotating coverage across the Behavioral Health, Dental and Medical front desk.
11. 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.
12. Ensure scheduled appointments are scheduled within scheduling guidelines, PCP assignments are accurate, forwards HEDIS insurance print outs to medical staff and communicates any discrepancies to immediate supervisor and provider.
13. Completes administrative check offs by reviewing patient EHR, scheduling system (ECW) 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 with medical records policy and guidelines.
14. 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 with billing guidelines.
15. Scans all insurance verification to EHR, edits creation date, and double checks for readability and accuracy.
16. Ensure the medical schedules remain booked by calling patients from the “waiting list”.
17. Other duties as assigned.

 

 

Performance Metrics and Accountability:

The Patient Service Representative will be evaluated on the following key performance indicators to ensure high-quality service delivery and efficient patient access to care:

 

Category

Performance Metric

Standard / Expectation

Call Management

Maintain overall call abandonment rate below 7%

≤ 7% abandonment rate

 

Average hold time per patient call

≤ 60 seconds

Scheduling Accuracy

Schedule all appointments in the correct appointment type and slot per department protocol

100% compliance

 

Ensure same-day and next-day appointment requests are routed appropriately for triage

 

 

100% compliance

 

Data Accuracy

 

Collect and verify correct patient demographic and insurance information at each encounter

100% accuracy

 

Maintain up-to-date and complete EHR documentation

100% compliance

Customer Service

Demonstrate professionalism and empathy during all patient interactions

≥ 90% positive feedback (via audits or surveys)

Follow-Up & Communication

Ensure all Tele-Encounters (TEs) are sent to the correct inbox and addressed within the same day

100% same-day completion

 

 

Qualifications:

 

Minimum Qualifications:

 

To successfully perform this job, the individual must be able to fulfill each essential duty and responsibility outlined in this position with performance standards. The qualifications listed below represent the necessary knowledge, skill and ability required.

1. High School Diploma or GED (equivalent).
2. 2-3 years related experience and/or training, or equivalent combination of education and experience.

Preferred:

1. Experience serving a multinational, multicultural population.
2. FQHC background.

1. Familiarity with Community Health Clinics and/or Indian Health Clinics.

1. ECW EHR.

 

 

Special Conditions of Employment:

1. CPR/ BLS certification: Maintain a current Basic Life Support (BLS) certification issued by the American Heart Association (AHA), the American Red Cross, or an equivalent organization. Certification must include an in-person, hands-on skills assessment. Online-only certifications are not accepted.
2. Annual background checks: Consent to annual background checks as a condition of continued employment, to ensure compliance with organizational standards and eligibility requirements.
3. For-Cause Drug Screening: Comply with drug screening requirements when initiated by the organization for cause, to support a safe, compliant, and drug-free workplace.
4. Ongoing Compliance Requirements: Maintain up-to-date compliance with all required annual renewals, including professional licenses, certifications, physical examinations, TB testing, and mandatory regulatory trainings as assigned by the San Diego American Indian Health Center (SDAIHC).  

 

 

Knowledge, Skills, and Abilities:

1. Strong oral and written communication skills.
2. Exceptional time management skills
3. Highly organized and attention to detail.
4. Capable of maintaining confidentiality and accurate record-keeping.
5. Strong interpersonal skills.
6. Ability to interact effectively with diverse individuals.
7. Demonstrates the ability to establish and sustain cooperative working relationships throughout the course of work.
8. Competence in performing basic mathematical calculations is necessary for job responsibilities.
9. Dependable and highly trustworthy.
10. Proficiency in Microsoft office suite or similar software programs.

 

Physical and Mental Requirements:

 

Physical demands outlined below represent those required to successfully perform the essential functions of this job, without accommodation.

Physical and Mental Requirements: continue

 

1. Ability to lift and move up to 10 pounds and navigate between locations as needed.
2. Capability to remain seated at a desk and operate a computer for extended periods.
3. Physical stamina to stand, bend, and reach for prolonged durations.
4. Strong analytical skills, with the ability to perform mathematical calculations, organize and prioritize tasks, and maintain productivity under pressure.
5. Demonstrated ability to supervise, manage multiple tasks simultaneously, and comprehend and follow instructions accurately.

 

Customer Service:

 

1. Actively champions and upholds the Mission, Vision, and core values of SDAIHC through consistent actions and commitment.
2. Demonstrates outstanding customer service in all interactions with internal and external stakeholders, fostering positive and respectful relationships.
3. Embodies SDAIHC’s Standards of Customer Service Behavior, including Compassion, Positive attitude, Effective Communication, Professional Appearance, a Strong Sense of Ownership, and Collaborative Teamwork.
4. Continuously engages in customer service training and professional development to enhance skills and maintain best practices.
5. Proactively promotes SDAIHC’s reputation as a leading service organization through every interaction, demonstrating professionalism and dedication.

 

Quality Management:

 

1. Actively contributes to the organization's success by engaging in quality improvement initiatives and demonstrating a commitment to continuous enhancement of services.
2. Strictly adhere to all SDAIHC policies and procedures while proactively supporting the adoption and implementation of new organizational initiatives.
3. Participate in and champion ongoing quality improvement efforts as directed by clinic leadership, fostering a culture of excellence and innovation.  

 

Safety:

 

1. Maintain strict compliance with all regulations, policies, and procedures related to safe work practices, consistently prioritizing workplace safety.
2. Actively engage in infection prevention by adhering to best practices and implementing appropriate infection control measures during patient care and interactions.
3. Ensure full compliance with regulatory standards to maintain the safety of the physical environment, including equipment and supplies, promoting a secure and hazard-free workspace.
4. Utilize all necessary tools and equipment effectively to uphold workplace safety and reduce potential risks.
5. Promptly identify and report any unsafe working conditions to ensure immediate corrective action and maintain a safe working environment.    

           

Privacy/Compliance:

           

1. Upholds the highest standards of privacy and security for all patients, employees, and volunteers by strictly granting access to information solely on a need-to-know basis for legitimate business purposes.
2. Demonstrates unwavering commitment to corporate integrity by adhering to all relevant regulations and promptly reporting any unethical, fraudulent, or unlawful behavior or activities.
3. Consistently exempl