Patient Assistance Representative
Position Summary: The Patient Assistance Representative is responsible for reviewing all patients at all sites on treatment to check for eligibility for all pharmaceutical and non-profit programs available. This individual is also responsible for reviewing patient account copay assistance balances, and files it to the correct program. This individual must be flexible due to the constantly changing patient assistance program rules/requirements as well as have knowledge of same. This individual must have ability to communicate well with the patients, patient assistance programs, and providers. This position also requires completion of all patient assistance applications for insured, underinsured and uninsured patients. Work is performed under the general supervision of the Revenue Cycle Manager.
Essential Duties and Responsibilities:
- Handle inbound and outbound patient, clinical staff and physician calls regarding various patient assistance programs.
- Screens all new patients for eligibility of enrollment into different pharmaceutical and non-profit program(s) by reports and task list in the EMR.
- Communicate with patient about details and benefits about the program(s), and enroll patient into program(s) with proper documentation.
- Communicate directly with physicians and clinical staff to ensure signatures on paperwork and prescriptions to submit to the patient assistance programs.
- Works directly with the PreCert Team to verify criteria and qualification for each patient and dosing schedule.
- Completes application(s) for each patient via PDF, email or electronic portal for each program along with proper income documentation.
- Resolve billing issues/questions from both patient assistance programs and patients by phone, fax, mail or portal.
- Works directly with Revenue Cycle Manager, Director of Reimbursement and the PreCert Team to ensure proper workflow.
- Reviews patients’ financial capabilities if not covered by insurances.
- Explains the financial screening application process, if needed.
- Respects the dignity and confidentiality of patients.
- Maintains a good attendance record and report on time for work.
- Maintains a professional attitude and appearance.
- Complies with clinic safety policy and procedures.
- Possesses good communication skills that lend to a team oriented work environment.
- Attends staff meetings as scheduled.
- Assists with training and orientation of new employees as assigned.
- Performs other duties as assigned.
- Some travel to satellite offices may be required.
Qualifications/Experience:
High school diploma or G.E.D. required and a minimum of two to three years experience in insurance verification in a medical environment. Bilingual is a plus. Data entry skills required; proficiency in 10-key by touch.
Must have excellent organization and follow-up skills; excellent verbal and written communication skills; excellent problem-solving skills; ability to organize and prioritize work assignments; ability to handle multiple priorities in a fast-paced environment; ability to analyze situations and respond in a timely manner; ability to participate in multi-functional teams; ability to establish and maintain effective working relationships within The West Clinic. Must be proficient in computer applications including word processing and e-mail. Additional hours may be required.
Work Environment/Physical Demands/Travel:
- Typical clinical environment with moderate noise level.
- Ability to sit, stand, walk, reach, climb or balance, stoop or crouch, use hand/wrist, talk, see, and hear for extended periods of time.
- Ability to read and understand documents such as safety rules, operating and maintenance instructions, procedure manuals, correspondence. Ability to write routine reports and correspondence. Ability to speak and present information in small groups of customers, suppliers, or employees of the company.
- Ability to calculate figures and amounts such as discounts, interest, commissions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
- Ability to apply common sense understanding to carry out instructions given in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in routine situations.
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