Commence ยท 1 week ago
Patient Service Representative (Clerk III) | Medicare
Virginia Beach, VA
Full-time
Onsite
Entry, Mid Level
2+ years expCommence is a company focused on data-centric transformation in healthcare, aiming to improve health outcomes and streamline processes. The Patient Service Representative (Clerk III) role involves assisting Medicare beneficiaries, responding to inquiries, and maintaining effective communication with healthcare providers and stakeholders.
AnalyticsArtificial Intelligence (AI)Clinical TrialsCloud ComputingHealth CareSoftware
Responsibilities
Informs Medicare beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program
Assists with the review process to maintain required timeliness and accuracy as stipulated by the contract and the Quality Improvement Organization (QIO) manual
Acts as a neutral liaison for beneficiaries, their families, or their representatives
Informs Medicare beneficiaries, healthcare providers, and other partners of the activities and responsibilities of the QIO
Develops and maintains positive relationships with external and internal customers
Prepares correspondence to physicians, facilities, and other healthcare and community organizations as needed
Ascertains the most current and correct contact information, maintains accurate mailing lists, and coordinates mailings
Processes and maintains medical records
Tracks all telephone calls, essential conversations, and letters mailed to beneficiaries and providers using an electronic web-based application
Enters data into software applications timely and accurately
Participates in the continuous improvement process to identify quality issues and recommends solutions
Assists in preparation for International Standardization Organization (ISO) audits
Protects the confidentiality of beneficiary information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH)
Attends annual security awareness, rules of conduct, and conflict of interest training
Performs other duties as assigned
Qualification
Required
Experience as a call center representative or patient service representative
Considerable knowledge of business English, medical terminology, spelling, punctuation, vocabulary, filing, and general office methods
Working knowledge of the healthcare provider business and all the components of medical record documentation
Knowledge of Centers for Medicare & Medicaid Services (CMS), Medicare, and the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) programs
Associate degree in business education or health information management and two years of experience related to a majority of the primary duties of the job, OR Graduation from a secretarial school and three years of experience related to a majority of the primary duties of the job, OR High school diploma or General Education Development (GED) with four years of experience related to most of the job's primary duties
Two years of experience and skill in Microsoft Word and Microsoft Excel spreadsheet programs
Must possess excellent oral and written communication skills
Must be attentive to detail
Familiarity with database software programs (e.g., Microsoft Office)
Must possess excellent interpersonal and problem-solving skills
Must possess essential knowledge of medical terminology and components of medical record documentation
Working knowledge of CMS, Medicare, and the QIO programs
Ability to exercise sound judgment
Ability to organize and coordinate multiple simultaneous tasks in a team environment
Ability to maintain effective working relationships and communications with providers and stakeholders
Ability to collect data and distinguish relevant material
Ability to maintain objectivity
Ability to work independently
Ability to give and receive feedback
Company
Commence
Commence delivers AI-driven healthcare data platform and clinical expertise that supports analytics, decisions, and workflow improvement.
501-1000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase