Access Care Representative

Job Title:     Access Care Representative

 

Pay Range: $23.50- $30.00

 

Location: City Heights

 

Reports To:     Call Center Manager

 

Job Status:      Full Time / Non-Exempt

 

 

Summary

 

The Access Care Representative’s primary responsibility is to provide efficient and professional customer service to patients, providers, coworkers and other stakeholders via phone, email, messages, or other channels. This role involves answering inquiries, scheduling appointments, verifying information, and addressing concerns, all while maintaining confidentiality and adhering to healthcare regulations. The Access Care Representative is also responsible for verifying eligibility for every patient prior to scheduling to determine coverage. Customer service is a core competency for Access Care Representatives.

 

 

Tiers

_____________________________________________________________________________________

Tier 1

Entry-level professional with limited or no prior experience; learns to use professional concepts to resolve problems of limited scope and complexity; works on developmental assignments that are initially routine in nature, requiring limited judgment and decision making. Knows fundamental concepts, practices and procedures of field. Handles basic inquiries, such as scheduling appointments, answering general questions, or providing simple information. These agents often have a broader range of knowledge about the organization and its services.

 

Tier 2

Professional with 3-5 years of experience and proficient in EMR (such as NextGen, EHR, eClinicalWorks and etc.). Applies acquired job skills, policies, and procedures to complete substantive assignments/projects/tasks of moderate scope and complexity; exercises judgment within defined guidelines and practices to determine appropriate action.

 

Tier 3

Professional with 5 or more years of experience and proficient in EMR (such as NextGen, Epic, eclinicalworks and etc.) Knows how to apply theory and put it into practice with in-depth understanding of the professional field; independently performs the full range of responsibilities within the function; possesses broad job knowledge; analyzes problems/issues of diverse scope and determines solutions. Assists with handling escalations, train staff, ensures compliance, and optimize call center processes.

 

 

Responsibilities (including but not limited to):

 

• The Access Care Representative will greet and handle inquiries and appointments via telephone in a promptly and timely manner.
• Addressing customer questions regarding appointments, billing, insurance, programs and other healthcare-related topics.
• Scheduling, rescheduling, and confirming appointments based on patients needs and urgency.
• Verifying Information: Gathering and verifying patient demographic and insurance details.
• Maintain effective communication and working relationships with other employees, departments and patients
• Maintain attention to detail with every call, in order to schedule accurately while following the patient’s PCP and Care teams
• Addressing Complaints: Handling patient complaints and concerns professionally and empathetically.
• Documentation: Maintaining accurate records of patient interactions and inquiries.
• HIPAA Compliance: Ensuring adherence to HIPAA regulations to protect patient privacy.
• System Proficiency: Utilizing call center software, electronic health records (PM & EHR), Phreesia and other relevant systems.
• Communication Skills: Providing clear and concise information to patients, manager and other stakeholders.

 

• Maintain effective communication skills with patients. This includes listening skillfully and displaying a willingness and ability to acknowledge patient needs, expectations and values through the use of reflective listening and empathy conveyance. Responds to patient needs in a way that is helpful and beyond expectation.
• Answer telephones (includes scheduling appointments) and provide information on Clinic operations following La Maestra’s established Phone Call Etiquette
• Schedule appointments using the PCMH script
• Assign patients to a Primary Care Provider (see PSR Procedures and Protocols)
• Always maintain La Maestra’s Phone Call Etiquette (see PSR procedures and Protocols)
• When asking patients whether their visit is an emergency room follow-up, the ACR must:
  • Ask whether their appointment is an ER follow up without the patient having to do so
  • Inform the patient that their physician WILL NOT be able to give them the proper appointment without their emergency room records therefore the patient needs to be assisted by a Case Manager first to retrieve the records. The process for getting the emergency room records is lengthy, resulting in an elongated wait time.
• Check emails and department messages and take appropriate action (i.e. call back patient, schedule appointment, forwarding message information to intended recipient, etc.)
• Responsible for being familiar with the basic guidelines and standards of the government programs the Clinic is engaged in and patients’ use, in paying for services. Become and remain familiar with common private insurance company basic guidelines and standards
• Maintain office supplies and reorder as necessary
• Other functions as directed by the Supervisor
• Follow up on the no show patients (the day appointment was missed)
• Appointment Confirmations: Call patients to remind them of scheduled appointment, check in time, and what they need to bring. (1 or 2 day prior to the appointment, this based on department)
• Responsible for assisting patients with linkages to clinic services and other community-based services as needed
• One third of receptionists’ performance includes patient satisfaction levels. Performance Appraisal will include the level of patient satisfaction, accuracy of appointment setting, patient intakes for and for registration of patients.

 

 

Additional Duties and Responsibilities

 

1. Attend staff meetings
2. Performs other duties as assigned.
3. Comply with and remain up to date with all policies, procedures, and protocols outlined in the Patient Services Representative Manual and the Patient Services Representative Procedures and Protocols (attached).

 

 

Patient Centered Medical Home Essential Responsibilities (Principals)

• Collaborate with individual patients, their personal physicians, and when appropriate the patient’s family to ensure accessible, comprehensive, compassionate, and culturally competent care

• Facilitate care by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

• Ensure all decisions respect patients’ wants, needs, and preferences and that patients have the education and support they require to make decisions and participate in their own care.
• Continually strive to attend to each patients “whole person,” in the context of the patient’s personal and medical history and life circumstances, rather than focusing on a particular disease, organ, or system

 

Job Requirements

 

Education:  High School Diploma or equivalent required.

 

Certification:  Medical Assistant, Billing and Coding Certificate and/or Medical Office Administration preferred. CPR certification required.

 

Experience: 1-2 years’ experience in a physician office or hospital setting as a Patient Services Representative or registration preferred.

 

Verbal and Written Skills to perform the job:  Bilingual (English/Spanish), (English/Arabic) preferred. Familiarity with basic word processing, spreadsheet, and database applications.  Accurate keyboarding skills.

 

Technical knowledge and skills required to perform the job: Excellent verbal, written and interpersonal communication skills and the demonstrated ability to work with diverse individuals and groups.  Demonstrate high levels of self-initiation and direction. Knowledge of communities we serve. Knowledge and experience working in medical settings and interacting collaboratively with medical teams.  Skill in analyzing situations and making timely decisions.

 

Physical and Mental Requirements:  Work involves sitting, talking, hearing, using hands to handle, feel or operate objects, tools, or controls, and reaching with hands and arms. The employee may be required to push, pull, lift, and/or carry up to 20 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

La Maestra Community Health Centers is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation or belief.