Job Title : Patient Care Representative

Department : Patient Services

Reports To : Patient Services Manager

FLSA Status : Non-exempt (hourly)

Work Schedule: Monday-Friday, 8:00 A.M. - 5:00 P.M.

Summary: The Patient Care Representative is a vital role within Orthopaedics East & Sports Medicine Center. The Patient Care Representative will be responsible for coordinating patient surgeries, (while supporting the teams that schedule MRIs, injections, and physical therapy appointments), managing messages and correspondence from patients, offering financial counseling to patients, supporting the referral process, and serving as the authorization representative for insurance companies. The Patient Care Representative will work closely with our team of healthcare professionals to ensure that all patients receive high-quality care and attention.

This position requires compliance with OrthoEast’s compliance standards, including its Code of Conduct, Compliance Program, and policies and procedures. Such compliance will be an element required as part of the job duties and considered during performance evaluations.

Essential Duties and Responsibilities:

The Patient Care Representative will be responsible for the following:

• Coordinating patient surgeries, ensuring that patients are scheduled for the appropriate procedures and that all necessary paperwork is completed.
• Maintain and review a list of surgeries for provider(s) for potential contact and follow-up within the post-op period.
• Serving as the authorization representative in conjunction with our support team, ensuring that patients receive the necessary coverage for their procedures.
• Obtain authorizations and schedule referrals, diagnostic testing, physical therapy, surgical procedures, etc. as needed.
• Offering financial counseling to patients, providing information about payment options and financial assistance programs.
• Managing messages and correspondence from patients, responding to inquiries and forwarding messages to the appropriate healthcare professionals.
• Counsel patients and family members regarding physical care measures to promote improvement/recovery, symptom/complication management, expected outcomes/progression and social employment issues and education so they can make informed decisions about their care.
• Additional duties as assigned.

Required Qualifications:

The following qualifications are required for the Patient Care Representative position:

• Associate degree in healthcare administration, or related field preferred.
• Minimum of 2 years of experience in a healthcare setting.
• Minimum of 2 years of patient support experience.
• Knowledge of medical terminology and procedures.
• Knowledge of insurance authorization and billing.
• Strong computer skills, including proficiency with Microsoft Office and electronic medical records systems.

Soft Skills:

The following soft skills are required for the Patient Care Representative position:

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  Ability to prioritize tasks and work independently.
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  Experience in maintaining confidentiality in dealing with sensitive issues.
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  Proven ability in making sound and accurate judgments in problem solving work issues.
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  Ability to deal with frequent change, delays, and/or unexpected events.
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  Successful record of follow through on commitments and demonstrated dependability.
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  Must be willing to work in a team environment and contribute to building a positive team spirit.
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  Must be highly organized to successfully manage multiple tasks simultaneously.
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  Must demonstrate professionalism in all interactions with patients and vendors, as well as working across departmental lines to achieve goals.

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.

The ability to stand/walk for long periods of time while performing patient duties and conversing with physicians as well as long periods of sitting and performing clerical duties, including telephone calls and keyboarding. Mobility also required to support patients throughout the building.