Health Services Representative

(Positions may perform any of the following tasks, depending on the area of assignment. No single position will encompass all the tasks listed, nor is the list below exhaustive.)

• Interviews clients to obtain personal and financial data and to determine ability to pay for hospital and/or medical services or program eligibility;
   
• May suggest alternative services, programs or additional insurance coverage available to clients for a variety of Federal, State, and County programs, including Medi-Cal, Medicare and special programs;
   
• Prepares insurance billing forms including Medi-Care and Medi-Cal;
   
• Prepares medical admission packets and medical record file setup including all required departmental forms, releases, and identifying labels;
   
• Queries and inputs registration and billing information in the computer and reverts to manual system on stat admissions and/or computer down time;
   
• Prepares necessary documents for emergency medical admissions;
   
• Uses cardwriter/imprinter to prepare identification cards for billing purposes, issues receipts, and may use a variety of office equipment;
   
• Answers telephones and responds to inquiries regarding emergency medical treatments;
   
• Refers callers appropriately according to their needs; refers all medical information and advice calls to the telephone advice nurse or clinic RN and processes messages for providers/nursing staff as needed;
   
• Assists clients with completion of forms and paperwork;
   
• Maintains a back up log book of admissions;
   
• Deals with law enforcement agencies and ambulance personnel regarding emergency admissions;
   
• Notifies relatives of emergency ambulance admittance;
   
• May follow through to obtain necessary information when client is unable to respond;
   
• Provides information to the public or to staff that requires the use of judgment and the application and interpretation of policies, rules or procedures;
   
• Arranges for transportation of patients via Taxi, Medicar, Hospital Transportation Service, Outreach or in emergency situations, with ambulance services;
   
• May estimate cost of certain medical services, arrange payment plan, and collect payments for medical services rendered;
   
• Schedules appointments for a variety of medical clinics, either by telephone or in person utilizing a computerized patient registration system;
   
• Maintains appointment books for a variety of medical clinics;
   
• Advises clients of specialty clinics, billing procedures and diagnostic procedures;
   
• Telephones clients to remind them of future appointments;
   
• Maintains and updates patient location;
   
• Classifies and codes diagnoses on clients' charge documents to ensure reimbursement for medical services;
   
• Classifies and codes a wide variety of diseases or medical condition according to the International Classification of Disease Standards;
   
• Maintains files, indexes and manuals on International Classification of Diseases;
   
• Posts medical statistics to daily log and compile reports on a regular basis;
   
• Reviews charge documents for compliance with policies and regulations;
   
• Prepares charge documents for batching and maintaining a log;
   
• Researches raw data or computer output to correct errors in registration, admission or billing entries or statistics;
   
• Assists in training and orienting new clerical and professional medical staff in the procedures of the unit;
   
• Performs other related duties as required.

Demonstrated education, training and work experience in a medical services setting which has provided an opportunity to perform a variety of moderately difficult medical office clerical tasks and an opportunity to acquire the following:

Experience Note: A qualified candidate would typically acquire the knowledge and abilities listed below by having one (1) year of work experience in a medical setting or agency program service site that required the use of medical terminology and direct contact with clients in a clinic, program service site or similar medical office setting.

Completion of a recognized medical assistant program can be substituted for six (6) months of the above work experience.

Knowledge of:

• Basic office practices and procedures including reception, filing and the operation of standard office equipment;
   
• General medical terminology;
   
• Interviewing techniques;
   
• Telephone courtesy;
   
• Basic policies and procedures related to medical client services, for processing insurance claims and/or billing charges;
   
• Modern office practices and procedures including basic computer skills;
   
• Hospital admitting practices;
   
• Purpose and use of International Classification of Disease Standards;
   
• Types and functions of the various Outpatient Clinics.

• Perform a variety of clerical duties under occasional stressful situations;
   
• Work effectively and prioritize conflicting tasks, sometimes in difficult and stressful situations;
   
• Type with accuracy and moderate speed;
   
• Prioritize work and coordinate several activities;
   
• Explain, verify and/or clarify information necessary in the completion of the medical office clerical tasks;
   
• Make arithmetical computations of moderate difficulty;
   
• Organize and maintain accurate files and records;
   
• Establish and maintain effective working relationships with all levels of medical, professional, administrative and support personnel contacted in the course of work.