Career Opportunities

General Description

The Patient Service Representative performs a variety of tasks to the company in as much as it is the first contact via telephone by the prospective patient with the clinic. Essential duties include providing excellent customer/patient services via phone and in person; referring callers to the appropriate departments; making appointments for patients according to established company protocols; assisting patients/clients with forms. The position is considered a crucial link between the patient and the care delivered by clinical and service staff of the center. The incumbent must work collaboratively with all Clinical services staff in support of direct patient services, exhibiting flexibility and a “can do” attitude. Patient services are the key priority in this position requiring the Patient Service Representative to serve as a point of contact with other internal and external departments, all with the goal of fostering an environment which promotes patient comfort and trust. The position must exemplify the core values and mission of the organization, always exercising utmost discretion, diplomacy and tact in patient/staff interactions.

Qualifications

Understands the importance of maintaining confidentiality; able to maintain confidentiality under HIPAA standards.
Must have the ability to exercise a high degree of diplomacy and tact; excellent customer services and interpersonal communication skills; Cultural sensitivity and demonstrated ability to work with diverse people groups.
Intermediate to advanced phone skills; able to effectively relate via the telephone and in-person to serve the needs of Clinic patients/clients/visitors in a manner that is efficient and productive.
Must be highly flexible; able to accommodate changing needs of the department.
Well-developed verbal and written communication skills in English; Additional language abilities desirable.
Knowledge of basic math and modern office procedures.
Ability to work well under pressure with minimal supervision. Proven flexibility and willingness to handle a variety of tasks.
Willingness to work variable shifts, including evenings.
Basic to intermediate computer knowledge and skills.
Training and/or experience with computer data entry and ability to type a minimum of 45 WPM.
Valid Maine Driver’s License, insurance, and ability to accept travel assignments as required to perform duties.

Responsibilities

Performs day-to-day administrative functions and general office duties including but not limited to word processing, copying, filing, faxing, answering phones and data entry.
Provides information to Clinic callers according to the Clinic’s Policies and Procedures; transfers calls as needed; works with central reception to ensure adequate phone coverage at all times.
Welcomes and greets patients/clients/visitors to the department in a manner that is helpful and friendly; determines purpose of visit and direct patients/clients/visitors to appropriate person or department(s).
Schedules patient flow to clinic based on predetermined appointment arrangements to allow the clinic to serve an adequate number of patients as established by grant requirements.
When scheduling appointment, carefully screens patients for new address, new patient visit or update registration and informs patient of adequate information that must be presented at time of visit.
Adheres to all Clinic policies on safety and security; maintains restricted areas safe by safeguarding keyless entry codes and computer system passwords in strict confidentiality.
Must exercise utmost diplomacy and tact to provide excellent customer service for patients; practices confidentiality and privacy protocols in accordance to Clinic policies and HIPAA requirements.
Maintains patient waiting areas, office files, and front-desk areas in a manner that is organized and neat.
Informs patient of any existing balance noted in computer and request patient be prepare for any payment due at time of visit.
Verifies method of payment for service (Medicare, Medicaid, private insurance, private payee, etc.) and collects data and/or payment as appropriate.
Exercises problem-solving and conflict resolution skills when handling patient complaints; refers patient complaints to appropriate designated personnel as needed.
Attends scheduled department staff and clinical meetings.
Performs all duties in support of successful EHR/EPM implementation.
Performs other duties as may be required.

Responsibilities

Perform initial intake, ocular and health history, medications list, preparatory for appointment with the physician
Perform patient testing as directed by physician, i.e. Tonometry; Fundus Photography; Refraction; Visual Fields; Topography, FA’s, OCT’s, PHP’s
Assist Ophthalmologist and/or Optometrist in all aspects of vision evaluation and treatment plan
Gathering information, medication records, administering topical medications
Maintain tidy and organized work space
Provides patient education/instruction (e.g. Glaucoma, Pre-and Post Op Surgical Instructions, Testing, Medications, Lid Hygiene, Drop Technique, etc.), as appropriate.
Performs patient triage, deferring to physician as indicated. Returns patient phone messages, providing information and/or test results as directed by physician(s)
Schedule appointments as needed
Answer and triage patient calls appropriately with associated documentation

Job duties include (but are not limited to) the following:

Perform initial intake, ocular and health history, medications list, preparatory for appointment with the physician
Perform patient testing as directed by physician, i.e. Tonometry; Fundus Photography; Refraction; Visual Fields; Topography, FA’s, OCT’s, PHP’s
Assist Ophthalmologist and/or Optometrist in all aspects of vision evaluation and treatment plan
Gathering information, medication records, administering topical medications
Maintain tidy and organized work space
Provides patient education/instruction (e.g. Glaucoma, Pre-and Post Op Surgical Instructions, Testing, Medications, Lid Hygiene, Drop Technique, etc.), as appropriate.
Performs patient triage, deferring to physician as indicated. Returns patient phone messages, providing information and/or test results as directed by physician(s)
Schedule appointments as needed
Answer and triage patient calls appropriately with associated documentation

Assists in the organization and daily function of the operating room in accordance with established federal, state and accreditation standards and facility policies and procedures. Assists in overseeing patient care activities in the operating room and maintains a high standard of safety for the patient and other staff members.

Minimum Requirements:

Education/Experience/Licenses/Certificates/Eligibility: Current Maine RN license, BLS and ACLS required. Two (2) years’ experience as an operating room nurse desired, IV skills preferred.

Eligibility: All employees must be able to provide proof of their identity and their right to work in the United States.

Clinical Skills

Assesses patient/significant others understanding of disease process and need for surgical intervention.
Performs pre/post-operative teaching to patient/significant other.
Demonstrates appropriate nursing management and intervention preoperatively and postoperatively.
Assess the patient for level of recovery from analgesia.
Provides effective airway management postoperatively.
Assesses and manages postoperative complications, such as nausea and vomiting.
Provides wound assessment and management to ensure uncomplicated wound healing.
Provides safe medication administration.
Manages patient complications/emergencies preoperatively and postoperatively.
Manages and documents controlled substance inventory.
Utilizes aseptic technique and infection control principles to establish and maintain intravenous access.
Reports significant patient information to medical staff appropriately.
Demonstrates knowledge and skill in caring for the latex sensitive patient.
Initiates and follows procedure protocol.
Demonstrates appropriate care for the patient experiencing pain.
Demonstrates techniques to relieve patient’s pain and evaluates the effectiveness of the techniques used.
Documents patient response during postoperative period.
Facilitates actions and activities that support accountability to practice.
Identifies and initiates problem resolution.
Actively participates, develops, and implements activities and measures promoting quality care.

Medical Records

Demonstrates knowledge of medical record policy and procedure in management of patient information.
Participates in medical records QAPI.

Communication

Listens respectfully, gives feedback directly, honestly and talks with others to clarify differences.
Utilizes translation services when needed.
Utilizes appropriate services when needed to communicate with employees and patients with speech and hearing disorders.

Quality

Demonstrates a willingness to look at new ideas and work in a changing environment.
Understands, verbalizes, and participates in the quality improvement process.
Supports initiatives designed to improve individual and organizational performance.
Provides appropriate patient care across the age span.

Identifies and reports suspected child, spousal/partner, and elder abuse per protocol.

Assists in the organization and daily function of the operating room in accordance with established federal, state and accreditation standards and facility policies and procedures. Assists in overseeing patient care activities in the operating room and maintains a high standard of safety for the patient and other staff members.

Minimum Requirements:

Education/Experience/Licenses/Certificates/Eligibility: Current Maine RN license, BLS and ACLS required. Two (2) years’ experience as an operating room nurse desired, IV skills preferred.

Eligibility: All employees must be able to provide proof of their identity and their right to work in the United States.

Clinical Skills

Assesses patient/significant others understanding of disease process and need for surgical intervention.
Performs pre/post-operative teaching to patient/significant other.
Demonstrates appropriate nursing management and intervention preoperatively and postoperatively.
Assess the patient for level of recovery from analgesia.
Provides effective airway management postoperatively.
Assesses and manages postoperative complications, such as nausea and vomiting.
Provides wound assessment and management to ensure uncomplicated wound healing.
Provides safe medication administration.
Manages patient complications/emergencies preoperatively and postoperatively.
Manages and documents controlled substance inventory.
Utilizes aseptic technique and infection control principles to establish and maintain intravenous access.
Reports significant patient information to medical staff appropriately.
Demonstrates knowledge and skill in caring for the latex sensitive patient.
Initiates and follows procedure protocol.
Demonstrates appropriate care for the patient experiencing pain.
Demonstrates techniques to relieve patient’s pain and evaluates the effectiveness of the techniques used.
Documents patient response during postoperative period.
Facilitates actions and activities that support accountability to practice.
Identifies and initiates problem resolution.
Actively participates, develops, and implements activities and measures promoting quality care.

Medical Records

Demonstrates knowledge of medical record policy and procedure in management of patient information.
Participates in medical records QAPI.

Communication

Listens respectfully, gives feedback directly, honestly and talks with others to clarify differences.
Utilizes translation services when needed.
Utilizes appropriate services when needed to communicate with employees and patients with speech and hearing disorders.

Quality

Demonstrates a willingness to look at new ideas and work in a changing environment.
Understands, verbalizes, and participates in the quality improvement process.
Supports initiatives designed to improve individual and organizational performance.
Provides appropriate patient care across the age span.

Identifies and reports suspected child, spousal/partner, and elder abuse per protocol.

General Description

A health care professional working to ensure that patients’ health care benefits cover required
procedures. The specialist contacts a patient’s insurance company to verify coverage levels and
works with individuals to educate them on their benefits information.

Reporting Relationships

The Insurance Eligibility Specialist reports directly to the Practice Manager

Qualifications

Understands the importance of maintaining confidentiality; able to maintain
confidentiality under HIPAA standards
Must have the ability to exercise a high degree of diplomacy and tact; excellent
customer services and interpersonal communication skills; Cultural sensitivity and
demonstrated ability to work with diverse people groups
Intermediate to advanced knowledge of insurance coverage and policies
Excellent multitasking skills
Detailed-oriented and organized
Ability to focus and work quickly to process paperwork in timely manner
Knowledge of basic math and modern office procedures
Basic to intermediate computer knowledge and skills
Ability to work well with various members of health care team
Ability to effectively communicate with various departments
Medical Terminology
Experience with insurance verification (Availity, Insurance Portals etc..)
Certification, Associates or bachelor’s in medical Coding, Billing Specialist or Medical
Science

Responsibilities

Validate individual and cross-patient insurance information for upcoming appointments
Perform accurate and concise data entry into practice management system
Obtain insurance referrals and authorizations as required
Communicate with patients about co-pays, benefits, coverage and care authorization
Liaise with patient, insurer and clinical team to communicate needs and current state of
coverage
Perform other duties as may be required

Measurable Goals

Verifies insurance coverage for all patients identified as failing and/or not processed by
RTS program in 5-day increments 100% of the time
Obtains authorizations as required 100% of the time
Notifies patients regarding lack of coverage for upcoming appointments 100% of the
time
Completes quota of verifications with accuracy