Patient Service Representative (Clerk III)

Job Details

Job Type

Full-time

Las Vegas, NV

Customer Service

Description

PATIENT SERVICE REPRESENTATIVE

(CLERK III)

Work Hours: Tuesday-Saturday 7am-3:30pm or Sunday-Thursday 8am-4:30pm

Summary/Objective:

The Patient Service Representative (Clerk III) ensures that beneficiaries are informed, updated, and assisted when necessary. This position responds to questions from beneficiaries, triages beneficiary calls, performs case intake, and staffs the Medicare Helpline as required.

Primary Duties:

• Informs Medicare beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program.
• Assists with the review process to maintain required timeliness and accuracy as stipulated by the contract and the Quality Improvement Organization (QIO) manual.
• Acts as a neutral liaison for beneficiaries, their families, or their representatives.
• Informs Medicare beneficiaries, healthcare providers, and other partners of the activities and responsibilities of the QIO.
• Develops and maintains positive relationships with external and internal customers.
• Prepares correspondence to physicians, facilities, and other healthcare and community organizations as needed.
• Ascertains the most current and correct contact information, maintains accurate mailing lists, and coordinates mailings.
• Processes and maintains medical records.
• Tracks all telephone calls, essential conversations, and letters mailed to beneficiaries and providers using an electronic web-based application.
• Enters data into software applications timely and accurately.
• Participates in the continuous improvement process to identify quality issues and recommends solutions.
• Assists in preparation for International Standardization Organization (ISO) audits.
• Protects the confidentiality of beneficiary information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH).
• Attends annual security awareness, rules of conduct, and conflict of interest training.
• Performs other duties as assigned.

Requirements

Essential Knowledge:

Experience as a call center representative or patient service representative. Considerable knowledge of business English, medical terminology, spelling, punctuation, vocabulary, filing, and general office methods. Working knowledge of the healthcare provider business and all the components of medical record documentation. Knowledge of Centers for Medicare and Medicaid Services (CMS), Medicare, and the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) programs.

Essential Education:

• Associate degree in business education or health information management and two years of experience related to a majority of the primary duties of the job, OR
• Graduation from a secretarial school and three years of experience related to a majority of the primary duties of the job, OR
• High school diploma or General Education Development (GED) with four years of experience related to most of the job's primary duties. Two years of experience and skill in Microsoft Word and Microsoft Excel spreadsheet programs.

Essential Skills:

• Must possess excellent oral and written communication skills.
• Must be attentive to detail.
• Familiarity with database software programs (e.g., Microsoft Office).
• Must possess excellent interpersonal and problem-solving skills.
• Must possess essential knowledge of medical terminology and components of medical record documentation.
• Working knowledge of CMS, Medicare, and the QIO programs.
• Ability to exercise sound judgment.
• Ability to organize and coordinate multiple simultaneous tasks in a t am environment.
• Ability to maintain effective working relationships and communications with providers and stakeholders.
• Ability to collect data and distinguish relevant material.
• Ability to maintain objectivity.
• Ability to work independently.
• Ability to give and receive feedback.

Organizational "Fit" Considerations:

Works well with other patient service representatives and team members. Establishes and maintains good professional relationships with people on all levels within Company and physicians and others outside of Company. Schedules will vary and include weekends and holiday shifts.

SCA Coverage:

Company is a federal contractor under the McNamara-O'Hara Service Contract Act (SCA).

The McNamara-O'Hara Service Contract Act (SCA) covers prime contracts of over $2,500 entered into by the federal government and the District of Columbia. The principal purpose of the contract is to furnish services in the U.S. using service employees. The definition of "service employee" includes any employee engaged in performing services on a covered contract other than a bona fide executive, administrative, or professional employee who meets the exemption criteria set forth in 29 Code of Federal Regulations (CFR) 541. Under the SCA, covered employers must pay the prevailing wages and benefits in the localityas determined by the U.S. Department of Labor (DOL) in a wage determination.

The position of Patient Service Representative is considered a "service position" and is mapped to the Occupation Code and Title 01113 - General Clerk III of the current Wage Determination. For more information on this Occupation Code, please refer to the SCA Directory of Occupations at https://www.dol.gov/whd/regs/compliance/wage/SCADirV5/SCADirectVers5.pdf.

Wage Determinations and Employee Rights on Government Contracts are posted in break rooms (or an alternative location where labor law posters are displayed) for employees to review.

Livanta LLC is an equal employment opportunity / affirmative action employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All personnel processes are merit-based and applied without discrimination on the