Call Center Patient Services Representative

Job Description

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.

Primary Job Duties

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, inservices 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.
  
  

Appointments And Reception

• 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.
  
  

Medical Records

• 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.
  
  

Qualifications

• Education: High School Graduate or equivalent preferred. Some college business or computer course work essential.
• Licensure/Certification: AHA BLS certification required within 60 days of hire. Course work in medical terminology preferred
• Experience : 1-2 years working in a healthcare environment required. 6 months of direct NorthBay 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 dynamic customer service experience preferred.
• Skills: Strong organizational and written and spoken communication skills essential. Demonstrated mastery of practice management systems is required with CPT, ICD9 coding experience beneficial. Experience in the following areas preferred: appointment scheduling, registration process, insurance verification, primary care preventive care. Demonstrated ability to work independently on a variety of complex tasks, managing competing deadlines. Bilingual capability preferred.
• Interpersonal Skills/Customer Service: Demonstrates the True North values. The True North values are a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at NorthBay Health. The True North values principles consist of Nurture/Care, Own It, Respect Relationships, Build Trust and Hardwire Excellence.
• Compensation: $26 to $32 per hour based on years of experience doing the duties of the role.
  
  

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About Us

At NorthBay Health, we are guided by our values: Nurturing Care; Own It; Respect; Build Trust; and Hardwire Excellence. These principles lead us to our TRUE NORTH and inspire us to provide exceptional care.

These values serve as the foundation of everything we do, guiding us to deliver individualized care with integrity and accountability. We are committed to fostering a culture of collaboration, where every team member is valued and empowered to contribute their best to the health and well-being of those we serve.

This is an exciting time to join NorthBay Health.

As an independent, nonprofit health system north of the San Francisco Bay Area, in the Napa/Solano Region, we are expanding our footprint across Solano, Yolo, and Napa counties to meet the evolving needs of our communities. With two acute-care hospitals—including a Level II Trauma Center and a modern maternity unit with a Level III Neonatal Intensive Care Unit (NICU)—along with a comprehensive cancer center, multiple urgent care facilities, and a growing network of primary and specialty clinics, we are investing in the future of care across the region.

NorthBay Health we are home to advanced clinical programs and nationally recognized cardiovascular, neuroscience, and orthopedic services, as well as comprehensive surgical and outpatient specialties. Our commitment to excellence is reflected in our Magnet with Distinction designation for nursing (one of only 12 organizations nationwide) and recognition from U.S. News & World Report as “High Performing” in multiple clinical areas, including maternity care, heart failure, and stroke. NorthBay Medical Center has earned the High Performing designation in maternity care for four consecutive years.

As the only locally governed health system in the region, we remain deeply rooted in our communities while growing into a trusted regional healthcare leader. If you are seeking meaningful work, collaborative teams, and the opportunity to help shape the future of healthcare in Northern California, you will find it at NorthBay Health.

Join us with our commitment to excellence, to achieve our vision to be the trusted healthcare partner of choice for the communities we serve.

To learn more about NorthBay Health's benefits, diversity statement and community please visit https://www.northbay.org/careers/