Patient Services Representative - GVHP Call Center

At Northbay Health, the Call Center Patient Services Representative performs general office duties including appointment scheduling, determining and verifying insurance eligibility, and processing of detailed messages to physicians. The Patient Services Representative functions as part of a clerical, clinical, and customer service team in support of primary care practices.

At Northbay Health, the Call Center Patient Services Representative performs general office duties including appointment scheduling, determining and verifying insurance eligibility, and processing of detailed messages to physicians. The Patient Services Representative functions as part of a clerical, clinical, and customer service team in support of primary care practices.

• Registration and Charge Entry
• Gathers, updates and verifies a comprehensive package of registration and insurance/payer information and ensures accurate entry into the practice management system.
• Provides information to patients regarding the selection process for a primary care physician, assists in determining insurance eligibility, co-payments, share of costs and other financial responsibilities for services rendered.
• Verifies and documents eligibility for all payers.
• Reviews benefit plan/s with patient to determine specific allowances and/or restrictions based on services requested.
• Researches and answers inquiries related to claims, eligibility and referrals.
• Ensures the accuracy of demographic and insurance information in accordance with the policies, procedures and service expectations of each department.
• Maintains professional standards by actively participating in committees, in services and QI activities and standards development.
• Acts as a resource to new and existing staff in personal areas of subject matter expertise.
• Presents a professional demeanor in appearance and attitude.
• Floats to other areas as needed.
• Performs other duties as assigned.

• Obtains complete demographic information for new patients ensuring accurate entry into the practice management system. Confirms/updates demographic information for existing patients.
• Confirms eligibility/PCP assignment status for patients with WHA, Health Net or Solano Partnership insurance prior to scheduling appointment.
• Demonstrates effective listening skills to determine appropriate call routing.
• Schedules appointments on the phone in accordance with approved provider protocols and current scheduling policies, procedures and algorithms.
• Monitors provider schedules to ensure appointments are booked for correct type and correct time allocation.
• Places confirmation or rescheduling calls in accordance with scripted guidelines and current policy and procedures.
• Assists in physician schedule maintenance functions including coordination of physician absences with open appointment times.
• Gathers data and performs provider access audits.

• Adheres to System policies related to confidentiality of medical record information, transcription and copies or distribution of medical record content.
• Handles patient documents appropriately to ensure patient confidentiality.

• High School Graduate or equivalent preferred.
• Some college business or computer course work essential.

• AHA BLS certification required within 90 days of hire.
• Course work in medical terminology preferred.

• 1-2 years working in a healthcare environment required.
• 6 months of direct North Bay Call Center training/experience can be substituted for healthcare experience.
• 1-2 years direct experience working in a call center environment preferred.
• Strong experience in insurance verification preferred.
• Strong communication skills and…