Patient Service Specialist (Clinic)

Cherishing Our Children Since 1977

Helping children and families help themselves to live a better life and build a stronger community.

The Center for Family and Child Enrichment (CFCE) is dedicated to helping children and their families by providing the right services and solutions based on individual needs. CFCE is constantly evolving to better support our community.

As an Patient Service Specialist , you will provide administrative and customer service support to patients and the medical staff. The Patient Services Specialist (Specialist) works in collaboration with providers and care center staff to assess healthcare needs, identify any barriers to care, and support patients in their health and wellness goals. The Specialist is the main point of contact for patients with the goal to build strong relationships and support patients in navigating health care by: identifying ways to improve the experience and delivery of care for each patient.

This role also involves tasks like scheduling appointments, managing patient records, handling billing inquiries, and ensuring a smooth patient experience. They are the first point of contact for CFCE patients, so strong communication and interpersonal skills are essential. In addition, the Patient Service Specialist is responsible for compiling and maintaining records of charges for services rendered at CFCE, that includes complete claims management from insurance submission to patient billing and cost center reconciliation with actual billing.

This position entails flexible work schedule with a one-hour lunch period.

Why join CFCE:

• You will make an invaluable impact in the community
• We offer growth and professional development opportunities
• You may qualify for Public Service Loan Forgiveness
• We offer benefits; PTO, Medical, Dental, Vision, 403b retirement plan and more for qualified positions.

FUNCTIONS: (job duties and responsibilities)

• Establishes close relationships with patients, building rapport and trust with patients in an empathetic manner.
• Assist patients in referrals, scheduling, accessing, and utilizing services with their primary care provider (PCP). If the patient does not have a PCP, support establishing a PCP.
• Maintain accurate and timely documentation of all patient encounters and complete reporting requirements according to organization standards.
• Track patient information, schedules, files, and forms in a confidential manner.
• Track patient attendance at medical appointments and initiate outreach on any missed appointments, providing education on the value of keeping appointments, as necessary.
• Outreach to patients after primary care appointments to review and update care plan, schedule future appointments and referrals.
• Able to identify symptoms of distress and act/intervene appropriately.
• Maintain strict confidentiality in accordance with department and organizational policies. • Other duties as assigned.

Billing and Claims Management

• Assist with the billing cycle, including creating, submitting, and tracking medical and dental claims to patients and third-party payers both manually and electronically.
• Monitor the accuracy of billing data and ensure proper use of CPT, HCPCS, ICD-10-CM codes.
• Reconcile claims data with clinical documentation and correct any discrepancies prior to submission.
• Follow up on unpaid or denied claims, initiate appeals, and resolve financial inconsistencies within billing cycle timeframes.
• Reconciling lab invoices with EHR system.
• Coordinating with the Revenue Cycle Manager on monthly A/R and providing EOB’s for Wrap compilation.
• Coordinating with other Revenue Cycle Manager for the LIP and fiscal audits.
• Assist in month-end closing processes and planning of special programs or billing initiatives.

Insurance Verification and Patient Eligibility

• Verify insurance coverage, eligibility, and pre-authorizations for all patients, including Medicaid, and non-Medicaid.
• Assist with the sliding fee scale assessments when needed.
• Contact insurance providers to confirm reimbursable services and payment rates.
• Ensure proper billing by assessing eligibility for coverage and applying appropriate billing rules.

 Customer Service and Patient Support

• Address patient inquiries and complaints related to billing with professionalism and empathy.
• Promote a customer-centric environment across front office and billing staff, ensuring patient satisfaction.
• Implement process improvements to enhance the billing experience and reduce patient complaints.
• Answering the phone to address patient inquiries and scheduling appointments
• Documenting insurance information, personal information, payment methods and other important patient information
• Updating patient files and appointment information accurately
• Communicating information and important details to other medical care staff
• Contacting insurance companies regarding coverage, preapprovals, billing and other issues
• Processing payments from patients and handling billing issues between patients and insurance companies
• Managing various types of paperwork and other clerical duties

Team Collaboration

• Collaborate with medical and dental providers to ensure billing accuracy and resolve discrepancies.
• Maintain a positive and cooperative working relationship with all staff, fostering a harmonious work environment.
• Participate in staff training, cross-functional meetings, and operational planning to support organizational goals.

  Other Duties

• Perform additional tasks as assigned to support departmental and organizational objectives.

MINIMUM REQUIREMENTS:

• Minimum of High School Diploma . Preferably Associates Degree in accounting/finance/business management preferred.
• Preferably two (2) or more years’ experience in the management of a Community Health Center in a Federally Qualified Health Center (FQHC) setting.
• Medical/Dental Health knowledge and experience required.
• Maintain current working knowledge of the health care environment as it relates to program operations.
• Must be detail oriented and possess excellent organizational, communication, management and supervisory skills.
• Must have an Accounting Background or Business background.
• Access to a well-maintained vehicle, valid auto insurance, and a current and valid Driver’s License

TECHNICAL SKILLS AND OTHER REQUIREMENTS:

Must be computer literate with proficiency in Windows, Microsoft Word, Outlook, Excel

• Word, Outlook, Excel and spread sheet applications
• Ability to perform at a high level of autonomy or with minimal supervision
• Ability to work a flexible schedule
• Ability to handle confidential information appropriately
• Ability to identify and understand environmental stressors
• Ability to set appropriate limits and boundaries with clients
• Knowledge of regulations related to Medicare, Medicaid and commercial insurance
• Knowledge and experience in all aspects of billing
• Strong verbal and written communication skills
• Requires exposure to the at-risk population.

CFCE is a Drug Free Workplace and an Equal Opportunity Employer.