Job details
Job type full-time
Full job description
Recent expansion at cummins behavioral health systems incHas a full-time career position as patient service representative located at our office in avon, indiana.
Job summary:
Under the general supervision of the centralized access team leader, the patient service representative performs essential centralized access functions pertaining to admission process including, inquiry, virtual access, scheduling, and authorization/denial managementSpecific job functions include:
Essential functions:
Answer incoming calls for new consumers.
Completion of the inquiry documentation.
Schedule new appointments and scheduling follow-up/cancelation/reschedules appointments.
Verify insurance to determine eligibility, deductible and co-payment amounts and obtain initial authorization and enter coverage plans.
Direct and assist new consumers to patient portal or cummins website to complete registration and clinical paperwork which includes completing the following:
Send email including guide on how to access portal/cummins website and instructions on downloading google and confirm receipt of email before getting off the phone.
Review needed forms to be completed prior to intake.
Explain the intake process and hours of open access and logging into our virtual waiting room to be seen by intake specialist
Review and verify all virtual access intake paperwork is complete and/or scanned into electronic health record and update electronic health record as needed and complete the registration process.
Monitors doxy.me waiting room for virtual access intakes:
Greets consumers in the waiting room.
Checks consumer in as new arrival in reception in electronic health record.
Collect co-pay or sliding scale as applicable.
Sends consumer to waiting room to complete intake with the intake specialist or refers next day access.
Assists with presumptive eligibility application and coordinates with local access
Sends links to release of information (rois) that are needed.
Updates waiting room when closed vsOpen
Utilizes therapist rotation list and panel provider list to send to intake specialist for 1st appointment.
Utilizes the county point person list as needed to help with schedulingIf consumer is from a county outside the organization, utilizes the county list to select which office would be best suited for the referral.
Makes virtual access intake outreach calls to consumers who called for inquiry but never did paperwork, who completed paperwork but never came into the waiting room, or who came to the waiting room, was unable to be seen and have not returned to the waiting room.
Sends text message reminders for virtual access intake appointments later in the day or will follow up via phone 30 min prior and fill spot if consumer is nonresponsive.
Completes tracking and reporting for virtual access.
Coordinates and report capacity needs with director admission to ensure needed coverage based demand.
Denial management which includes running reports to monitor authorizations about to be exhausted and about to expire, working denial log to resolve denials, coordinating pa process with the provider to obtain authorization for services, and loading authorization obtained in smartcare.
Checking medicaid eligibility verification for scheduled appointments and making necessary payor changes in smartcare, notifying outpatient office of changes, coordinate prior authorization process, and needed authorization for payor changes.
Completing reminder calls to consumers for outpatient appointments & missed appointmentsAlso monitor text messages.
Distributing incoming faxes to dept/person, scan to electronic health record and message appropriate staffFaxes managed: business office, centralized access and medical services (2 lines)
Completing mismatch report download and follow-up.
Demonstrates the ability to assess his/her own emotional responses to callers, co-workers and situations in which the worker`s values are challenged.
Readily demonstrates rapport building skills necessary to engage callers, referral sources, and others.
Medline requests completed & sent to appropriate medical staff.
Adherence to and promotion of the corporate compliance program at cummins behavioral health systems, inc.
Additional responsibilities: may be assigned other responsibilities as designated by supervisor.
Training and development:
Participates in continuing education programs and in-service training on request or in conjunction with developmental and training goals or as deemed appropriateto increase personal and professional effectiveness and improve the service quality provided to our consumers.
Policies and procedures:
Will support and demonstrate through his/her actions the philosophy of cummins behavioral health systems, inc., as well as its corporate mission, vision, and values.
Desired qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or ability requiredReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or experience:
Minimum of two (2) years of work experience in medical or behavior health office;
Previous experience with microsoft word and excel; and
High school graduate or equivalent preferred.
Knowledge, skills & abilities:
Ability to establish rapport quickly;
Ability to communicate and demonstrate problem-solving skills;
Ability to collect information from consumer and family members to determine nature and extent of consumer needs;
Ability to maintain ethical behavior in relationship with consumer;
Ability to provide courteous customer service to consumers and other staff members;
Ability to work efficiently and as a team member;
Ability to follow corporate guidelines related to personnel policies and procedures;
Computer operations as needed to enter and pull data;
Professional appearance and demeanor; and
Good attendance and punctuality.
Physical demands/work environment:
The physical demands and work environment characteristics described here are representative of those that must be met and/or encountered by an employee to successfully perform the essential functions of this jobReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit and talk or hearThe employee frequently is required to use hands to finger, handle, or feel objects, tools, or controls and reach with hands and armsThe employee is occasionally required to stand; walk; and stoop, kneel, crouch, or crawlThe employee must occasionally lift and/or move up to 25 poundsSpecific vision abilities required by this job include close vision, distance vision, depth perception, and the ability to adjust focus.
The noise level in the work environment is moderateRegular attendance is required.
Benefits include:
Competitive salaries
Excellent work life balance (paid time off and holidays)
Professional and leadership training and advancement
Diverse career tracts
Comprehensive insurance package
Clinical support from leaders in field
Matching contributions to your 401k program
Remote work option is available part office part virtual work options.
Learn about the many rewards of a career with cumminsApply today!
We`re an equal opportunity employerAll applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
