Patient Service Representative (Clerk III)

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. 

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.? 

The Patient Service Representative (Clerk III) ensures that beneficiaries are informed, updated, and assisted when necessary. This position responds to questions from beneficiaries, triages beneficiary calls, performs case intake, and staffs the Medicare Helpline as required. 

Primary Duties:

• 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. 

Essential Knowledge:

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. 

Essential Education:

• 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.

Essential Skills:

• 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. 

Organizational "Fit" Considerations:

Works well with other patient service representatives and team members. Establishes and maintains good professional relationships with people on all levels within Company and physicians and others outside of Company. Schedules will vary and include weekends and holiday shifts.

SCA Coverage:

Company is a federal contractor under the McNamara-O'Hara Service Contract Act (SCA). 

The McNamara-O'Hara Service Contract Act (SCA) covers prime contracts of over $2,500 entered into by the federal government and the District of Columbia. The principal purpose of the contract is to furnish services in the U.S. using service employees. The definition of "service employee" includes any employee engaged in performing services on a covered contract other than a bona fide executive, administrative, or professional employee who meets the exemption criteria set forth in 29 Code of Federal Regulations (CFR) §541. Under the SCA, covered employers must pay the prevailing wages and benefits in the locality—as determined by the U.S. Department of Labor (DOL) in a wage determination.

The position of Patient Service Representative is considered a "service position" and is mapped to the Occupation Code and Title 01113 – General Clerk III of the current Wage Determination. For more information on this Occupation Code, please refer to the SCA Directory of Occupations at https://www.dol.gov/whd/regs/compliance/wage/SCADirV5/SCADirectVers5.pdf.

Wage Determinations and Employee Rights on Government Contracts are posted in break rooms (or an alternative location where labor law posters are displayed) for employees to review.

Work Environment/Physical Demands 

The work environment and 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. 

This is an in-office position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch. 

Commence is an equal employment opportunity for employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law. 

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or [email protected]. Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.