Patient Services Representative

Working Group: Patient Services/Care Coordination

Reporting: Patient Services Supervisor

Role: Patients Services Representatives (PSRs) are the first and most frequent contact with patients, families, provides, and office staff who utilize Quantum Health's coordinated healthcare program. The PSRs operate in the call center and take approximately 50-70 phone calls per day. Their role is to serve as patient and provider advocate by answering all specific questions, while educating and guiding patients through the complicated process of healthcare. PSRs also follow-up on calls by completing research, solving problems, and contacting various parties to implement solutions. Compared to a typical healthplan call center, this position is more intensely focused on problem solving, patient advocacy, education and guidance.

Roles & Tasks: The Supervisor of Patient Services is responsible for determining the specific tasks to be performed by this position. These tasks include but are not limited to:

• Taking phone calls and/or internet inquires from patients, families, providers, and employer/client representatives and responding to inquiries regarding benefits, eligibility, claims, provider look ups and care coordination processes.
• Completely documenting all contacts with any of these parties.
• Coordinating activities among patients, providers, TPAs, PBMS, and any party affecting the healthcare of a patient, by acting as an advocate for the patient and assisting them to understand their healthcare processes and applicable benefits.
• Completing all necessary referral and pre-certification processes to support the care coordination process.
• Identifying and escalating issues as appropriate.