Job Posting: The Patient/Provider Services Representative has the responsibility of serving as the liaison between providers, patients, health plans and other internal departments. The position is the first point of contact for patients accessing Cedars Sinai Medical Group and Cedars Sinai Health Associates. In that capacity, the Patient/Provider Services Representative provides superior customer service, while welcoming the patient, educating them about the groups' programs and services and gathering and providing pertinent information to make their experience successful. ESSENTIAL EXPECTATIONS Sets the tone for customer service over the telephone. Strives to maintain the highest levels of data completion, accuracy, and quality. Understand how his/her position impacts the entire Medical Group's reputation, ability to grow and succeed, financial integrity, and health plan relations. Exhibits cultural sensitivity and attends related training classes as required. Displays a high degree of professionalism and respect for the patient as a customer. Maintains patient confidentiality. Maintains knowledge of the medical terminology, examination, diagnostic and treatment room procedures used in the physician practices. Is aware of compliance requirements per established policy and procedure and makes every effort to ensure compliance. DUTIES AND RESPONSIBILITIES
Assists patients who have managed care or fee for service insurance with their selection of a primary care physician by providing information about available physicians and following CSMG/CSHA policy regarding new patient assignment;
Answers patients' questions regarding CSMG/CSHA, its specialty network and contracted hospitals, and care delivery procedures;
Answers patients' questions regarding their benefit plans and co-payments and directs patients back to the health plans when necessary;
Verifies member eligibility via telephone, fax back or through the health plan web site and forwards information to enrollment for documenting in IDX;
Completes a thorough and accurate registration on each patient, including demographic and insurance information; collaborates with the Enrollment Department or Physicians' Billing as needed;
Follows departmental procedures for following up with patients for whom complete information was not obtained at the time of contact to ensure an accurate patient record by the time of the appointment;
Determines patient's appointment needs and schedules new patient appointment per protocol;
Confirms patient appointments, as instructed;
Effectively recognizes urgent and emergent calls and handles according to policy;
Educates patients about CSMG/CSHA programs and services and directs patients to the Website for further information;
Serves as liaison to physician practices and other CSMCF/CSMNS departments; assists patients through their interactions with these departments as necessary, to include follow-up with UM/Referrals Department on status of referrals as requested by provider/member and printing/faxing copies of approved referrals from GCS when necessary;
Acts as the member/provider liaison with the Claims and Physician Billing Departments as needed to resolve any claims/billing issues;
Tracks/trends all member, provider and health plan inquiries, concerns, complaints and grievances by types, area and provider for future reporting via Customer Service Module
Assists peers and members in the resolution of member and provider problems, complaints and/or grievances;
Refers patient concerns to supervisor or managers as necessary;
Ensures phones are covered at all times per policy and procedure; seeks to limit number of calls transferred, messages required and patient hold times whenever possible.
Performs other duties as assigned. Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
Qualification Requirements/Preferences: Education Certifications/Licensure Experience Physical Abilities High school diploma or general education degree (GED); 3 or more years experience in a medical practice, billing service, health plan or customer service department. Must have superior customer service skills and demonstrated knowledge of health insurance, managed care reimbursement and medical delivery system. Ability to tolerate high volume production and computer data entry standards. Ability to rapidly adjust thought process to multiple clients. Knowledge of IDX and PC skills preferred. . AA degree, BI-lingual a plus. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable 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 stand and talk or hear. The employee frequently is required to walk; sit; and use hands to finger, handle, or feel. The employee is occasionally required to reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision, depth perception, and ability to adjust focus.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scien...tists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.