General Information
| Job Description | MED OFC SVC CRD 2 | Working Title | Call Center Representative |
|---|---|---|---|
| Job Code | 009213 | Grade | |
| Department Name | Clinical Affairs Dept - D02007 | Department Head | Timothy Collins |
| Supervisor | Ophelia Pena | Effective Date | 10/25/2023 |
Position(s) Directly Supervised
| Job Code | Title | FTE |
|---|
Department Custom Scope
| Working in the call center, performs tasks to contribute to the efficient day to day operations and a positive patient experience. Working at assigned UCR clinic location, this position will primarily be the voice heard when customers and patients call UCR Health. Under the general supervision of the clinic manager and director of ambulatory operations, performs a full range of call center duties. Duties can include: prompt and courteous telephone assistance to callers, answer, screen and triage a high volume of incoming calls, verify financial and geographic eligibility, schedule/cancel patient appointments according to their insurance and assigned provider, schedule/reschedule/cancel patient appointment at the request of the patient, provider or clinic needs, verify and update patient demographics. Checks appointment availability across clinic sites and schedules patients accordingly and assists with appointment cancellations. Pre-registers callers and patients in the electronic medical record system and determines if the caller/patient qualifies after checking insurance eligibility. Screen patients for demographic accuracy and update demographics, verify insurance and update insurance data upon receiving calls for eligibility. Perform other duties as assigned by supervisor. This position may be assigned to work at various clinic locations in the inland empire. This position may be required to work different shifts, including evenings, weekends, and holidays. |
Education & Experience Requirements
Education Requirements
| Degree | Requirement |
|---|---|
| Medical Assistant Diploma. | Preferred |
| An Associate degree in business or related field. | Preferred |
Experience Requirements
| Experience | Requirement |
|---|---|
| A minimum of two (2) years of experience working in a front office role coordinating schedules and performing duties related to checking in patients. At least one (1) of these years should be in a medical clinic office or hospital setting where insurance verification and patient financial responsibilities are performed. | Required |
| Prior experience in working in an insurance company, with third party payers, and/or in credit/collections. Experience using standard office equipment and computers. Typing speed of 35 wpm, and previous electronic medical records experience (EMR). | Required |
License Requirements
| License | Requirement |
|---|---|
| Valid Driver License | Preferred |
Certification Requirements
| Certification | Requirement |
|---|
Educational Condition Requirements
| Condition | Requirement |
|---|
Key Responsibilities
| Description | % Time |
|---|---|
| Call Center: Process new patient and follow up referrals for appointments and in office procedures. Secure authorizations for incoming and outgoing referrals. | 20 |
| Call Center: Verify insurance coverage and eligibility and obtains insurance authorization for appointment and care plan. Reviews and maintains patient accounts, secures financial arrangements on self-pay balances prior to and during patient appointments, verifies and pre-registers patients. Contacts patients with self-pay or outstanding balances to ensure appropriate financial arrangements and obligation is collected at time of visit. | 15 |
| Call Center: Schedules appointment for patients, based on provider availability. Reschedules patient appointments at the request of the patient and/or provider. Daily appointment reminder calls and calls to patients that have no showed their appointments. Perform all preregistration duties for new patients prior to making an appointment, including entering all demographics, verify and enter insurance information and inform patients of any charges or fees due and based on the type of insurance. Provide clear and courteous instructions to the caller on where the appointment was scheduled and what documents to bring to the appointment. Assist with reminder call. Optimizes patients' satisfaction, provider time, and treatment room utilization by scheduling appointments in person or by telephone. | 15 |
| Address in-basket messages in a timely fashion. Assists providers and patients with access and navigation to the patient portal. Create and mail new patient information packets. | 10 |
| Call Center: Responds to patient inquiries concerning their bill and account balances to resolve internal accounting and billing errors working closely with UCR Health and responds to patient with disposition on concern. Ensures billing encounters reconcile daily patient schedule consistent with UCR Health policy. Maintains patient accounts by obtaining, recording, and updating personal, financial, and compliance information into the Electronic Medical Record (EMR). | 10 |
| Call Center: Greet incoming callers in a friendly and courteous manner, interact politely and helpful when assisting and providing required information to callers. Answers a high volume of clinic multi-line line and assist callers, triage calls, address complaints, retrieve and process voice message. | 10 |
| Special Projects / Travel: May participate in projects to enhance the clinic operations, patient experience, or compliance with regulatory agencies. May be required to travel to other clinic locations and the UC Riverside campus offices. | 10 |
| Protects patients' rights by maintaining confidentiality of personal and financial information. Protects patient confidentiality by making sure protected health information (PHI) is secured by not leaving PHI in plain sight and logging off the computer before leaving it unattended. | 5 |
| Office Inventory: Maintains business office inventory and equipment by checking stock to determine inventory level; anticipating needed supplies; placing and expediting orders for supplies; verifying receipt of supplies; scheduling equipment service and repairs. Keeps medical office supplies adequately stocked by anticipating inventory needs, placing orders, and monitoring office equipment. | 5 |
Knowledge, Skills & Abilities
| Knowledge/Skill/Ability | Requirement |
|---|---|
| Ability to maintain a work pace appropriate to the workload and ability to work well in a constantly changing environment. | Required |
| Must possess the skill, knowledge and ability essential to the successful performance of assigned duties. | Required |
| Familiar with medical terminology. | Required |
| Strong oral and written communication skills to effectively communicate with patients of varying ages, diagnosis, and multicultural backgrounds. Excellent customer service and strong interpersonal skills. Must demonstrate customer service skills appropriate to the job. Ability to recognize and handle customer complaints. | Required |
| Bilingual skills in English and Spanish. | Preferred |
Special Requirements & Conditions
| Special Condition | Requirement |
|---|---|
| Overtime | Required |
| Travel | Required |
| Shift Work (hours outside standard Mon-Fri 8AM-5PM work hours) | Required |
| Must possess or obtain a Valid CA Driver License in accordance with the California Department of Motor Vehicles, if driving a university/personal vehicle for university related business. | Required |
Other Special Requirements & Conditions
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Level of Supervision Received
| Supervision |
Environment
Working Environment
| Medical Center/Clinic |
Other Requirements
Items Used
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Physical Requirements
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Mental Requirements
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Environmental Requirements
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Critical Position
| Is Critical Position: Yes |