Patient Care Representative Job Description
Patient care representative
provides administrative support in maintaining materials such as documents, proposals, routine correspondence, spreadsheets, composing and preparing routine reports, and maintaining records in a variety of business software and database applications for electronic medical records, billing, data management.
Patient Care Representative Duties & Responsibilities
To write an effective patient care representative job description, begin by listing detailed duties, responsibilities and expectations. We have included patient care representative job description templates that you can modify and use.
Sample responsibilities for this position include:
Responsible for patient management, the flow of patients through the front office in an efficient and professional manner, the accurate coding of services rendered, over the counter cash management, verifying and communicating insurance and demographic information, extensive knowledge of the practice management system, including formatting, scheduling matrix, and inventory management
Act as first point of contact with patients by carefully evaluating the purpose of the call, carefully assessing their purpose, prioritizing their handling, and triaging the calls if indicated
Responsible for patient management, the flow of patients through the front office in an efficient and professional manner, the accurate coding of services rendered and over the counter cash management
Accurately collect, record and ensure distribution of patient information to appropriate staff
Coordinate internal and external phone communication among staff, patients and providers
Provide information regarding financial policies, registration requirements and referral resources
Collect co-payments and balances when necessary
Ensure proper referrals and authorizations are in place at time of check in
Initiate collection follow-up of all unpaid or denied claims with the appropriate Payer and/or Payers
Investigate claims and resolve discrepancies via phone, payer portals, fax, email, within the specified timeframes and within a compliant manner
Patient Care Representative Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Patient Care Representative
List any licenses or certifications required by the position: CPR, BLS, AHA, MA, GOLD
Education for Patient Care Representative
Typically a job would require a certain level of education.
Employers hiring for the patient care representative job most commonly would prefer for their future employee to have a relevant degree such as High School and Collage Degree in Education, Medical, Associates, Communication, Business/Administration, Medical Terminology, Graduate, Business, Healthcare, Technical
Skills for Patient Care Representative
Desired skills for patient care representative include:
ICD-9/CPT coding
Practice management system
Inventory management
Scheduling matrix
Hospital scheduling systems and electronic medical records
Medical office
Data entry
Medical terminology and medical office billing and operations
PCs
Desired experience for patient care representative includes:
Use multiple software systems throughout the course of the day
Maintains an appropriate level of productivity, as defined by Management and completes work accurately and timely with appropriate documentation
Acquire knowledge of payer’s claims processing guidelines, provider contracts payer’s payment policies and procedures
Availability to work a minimum of 40 hours per week and work in an independent and self-motivated manner to maximize daily efficiency
Past Medicare/Medicaid experience
Excellent understanding of the A/R process in relation to the revenue cycle good knowledge of healthcare, government and/or insurance industry
Patient Care Representative Examples
1
Patient Care Representative Job Description
Job Description Example
Our company is looking for a patient care representative. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for patient care representative
- Collaborate effectively with physicians, hospitals and medical staff to meet scheduling demands
- Greet and check in patients in a friendly and courteous manner in person and on the phone
- Ensure required authorizations are obtained and communicated to appropriate parties (insurance carriers, patients, ) in a timely manner
- Oversee the accurate coding, processing and invoicing of surgery, procedural and hospital charges
- In addition, supporting the Epic Training team with administrative tasks as needed
- Under the general supervision of the Health Clinic Supervisor, the Patient Care Rep/Medical Assistant II is responsible for overall patient management
- They will assist with the flow of patients through the front and back office in an efficient and professional manner, ensure accurate coding of services rendered and over the counter cash management, inputting of vitals into EMR, medical assisting duties, eligibility and verification of insurance benefits, electronic appointment scheduling, patient registration, phlebotomy if required and other special projects as required
- Under the supervision of The Saint John’s Health Clinic Operations Manager, Director of Supportive Care Program, incumbent is responsible for the oversight of a new service line called “Supportive Care” which provides care management and services for seriously ill patients across all locations of care
- Incumbent will be responsible for business functions, clinical operations and quality assurance activities
- Incumbent will manage telephone calls, appointment scheduling, coding and charge entry, coordination of care services with other physicians or third parties, taking minutes in meetings and administrative activities for the Program
Qualifications for patient care representative
- Ability to speak English and Mandarin
- Excel - pivot tables, filtering, editing, sorting
- Must be reliable, dependable and punctual and able to work efficiently and effectively with co-workers and management
- 2-5 years' experience in call center field
- Good tenure is preferred
- Pediatrics background a plus
2
Patient Care Representative Job Description
Job Description Example
Our company is looking to fill the role of patient care representative. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for patient care representative
- Incumbent is also responsible to perform special projects as needed to advance the goals of the Program
- Contact insurance companies to obtain verification of insurance eligibility
- Contact insurance companies to obtain prior-authorization for all surgical procedures
- Coordinate and ensure necessary surgical equipment is authorized by insurance company prior to surgical procedure scheduled
- Submit all HMO referral requests for post-op physical therapy, DME (Durable Medical Equipment) and home health
- Calculate surgical fees prior to scheduling surgery
- Under the general supervision of the Practice Site Manager, the Patient Care Representative I is responsible for the administrative duties of the facility
- These duties include managing patient flow through intake and check-out, answering incoming calls and routing appropriately, scheduling, obtaining authorization approvals, collecting payments, and other related duties as the job requires
- The Patient Care Representative I will collaborate with other clinical and administrative staff to provide coordinated and patient-centered care to Saint John’s Health Clinic patients
- Provides financial education to patients and family on insurance benefits and/or self-pay programs available
Qualifications for patient care representative
- Must be willing to float between multiple locations
- At least 2 years experience working with people in situations that are high-pressure and time-sensitive (either telephone or face-to-face), and that involve solving problems, making decisions, using excellent judgment and “customer service” skills
- Bilingual in English and Spanish with the ability to speak fluently
- Open to working Saturdays on occasion from 9am - 2pm
- Accurate Data Input
- Candidates that are bilingual in Spanish will be given preference
3
Patient Care Representative Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of patient care representative. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for patient care representative
- Patient management, the flow of patients through the front office in an efficient and professional manner
- Accurate coding of services rendered, over the counter cash management
- Verifying and communicating insurance and demographic information
- Be responsible for patient management, the flow of patients through the front office in an efficient and professional manner, the accurate coding of services rendered and over the counter cash management, management of patient charts and information, eligibility verification of insurance benefits, electronic appointment scheduling and patient registration, collection and submission of billing charge slips and other special projects as required
- Be responsible for patient management the flow of patients through the front office in an efficient and professional manner
- Accurate coding of services rendered and over the counter cash management
- Management of patient charts and information, eligibility verification of insurance benefits, electronic appointment scheduling and patient registration
- Collection and submission of billing charge slips and other special projects as required
- Be responsible for patient management, the flow of patients through the front office in an efficient and professional manner, the accurate coding of services rendered and over the counter cash management
- Be responsible for patient management, flow of patients through the front office in an efficient and professional manner, the accurate coding of services rendered and over the counter cash management
Qualifications for patient care representative
- ICD-9/ICD-10/CPT Coding
- Keyboard / type 45 wpm
- Speak/Read/Write English
- Prior billing or coding experience
- Experience in geriatrics, palliative care, or hospice environments
- Insurance Verification and Scheduling experience preferred
4
Patient Care Representative Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of patient care representative. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for patient care representative
- Schedule patients in a timely and accurate manner
- Be responsible for timely and accurate verification of patient insurance and demographic information and ensures the communication of this information to the appropriate staff
- Answer phones promptly
- Serve as a first line resource for PCR I, II and III by being a role model to staff members
- Provides customer service and support with the objective of exposing customers to new or additional products and/or services
- Able to multi-task to handle situations which require deviation from standard scripts and screens
- Completes necessary system navigation, call tracking, documentation and account billing
- Establishes relationships with third party partners including field sales, clinicians and insurance personnel
- Handles all calls with high customer satisfaction and retention
- Be responsible for the supervision of patient management, including the flow of patients through the front office in an efficient and professional manner, the accurate coding of services rendered and over the counter cash management
Qualifications for patient care representative
- Work Environment involves exposure to potentially dangerous materials and situations that require following extensive safety precautions and may include the use of protective equipment
- Initiates- work independently with minimum amount of supervision
- Experience in Managed care referrals and insurance authorizations including
- Associate's degree in marketing, communication, or relevant field
- Large scale event experience
- Bilingual in Spanish, Vietnamese, Arabic or other language
5
Patient Care Representative Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of patient care representative. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for patient care representative
- Flow of patients through the front office in an efficient and professional manner
- Accurate coding of services rendered
- Over the counter cash management
- This is a multitasking customer service role requiring superior and effective organizational skills
- Respond to incoming pharmacy calls and effectively resolve all callers concerns from patients, prescribers’ offices, insurance companies, and manufacturers, providing a one call resolution, if appropriate
- Create and build trusting, loyal relationships to ensure patient therapy continues and is maintained for optimum outcome
- Utilize effective listening to quickly assess caller’s needs
- Provide world-class customer service, working within the limits of prescribed routines
- Maintain effective and efficient response and superior service quality
- Respond to incoming calls from current patients and prescriber offices to process medication refills and schedule delivery
Qualifications for patient care representative
- This role is considered patient facing and is part of PIPC’s Tuberculosis screening program
- 1 year Customer Service experience in healthcare
- Goal oriented, competitive, and results driven
- Associate's Degreee
- Fluency in Japanese highly preferred
- Ability to act with Aveanna’s Vision and Values of Team, Accountability, Aggressive Improvements, and Delivering Excellence