Patient Service Representative

This position follows a hybrid schedule with 3 in-office days per week. Our office is located at 5 Neponset Street, Worcester, MA.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Adult Medicine has an immediate opening for a friendly, patient focused and detailed oriented Patient Service Specialist to join our team. The Patient Service Specialist is responsible for the completion of set processes and protocols. Works cooperatively with all members of the care team to support the vision and mission of the organization, deliver excellent customer service, and adhere to Lean processes. Supports the teams in meeting financial, clinical, and service goals.

This position is full time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm.

We offer 6 - 8 weeks of paid training. The hours during training will be 8:00 am - 5:00 pm, Monday - Friday.  Training will be conducted onsite.

Primary Responsibilities: 

• Supports a high volume of calls typically for a defined region/dept with back up support to a sister region/dept adhering to department productivity standards set forth by service line
• Screens all incoming patient inquires (through phone, or potentially mychart) to determine whether those inquiries can be appropriately handled by the Patient Service Representative or if they need to be directed to other team members. This includes chart review to identify previous activity that may have occurred related to the call
• Adheres to service line booking guidelines to ensure that clinic utilization is optimized safely and effectively as well as supporting the needs of our patients
• Initiates request for forms, letters, medication renewals, referrals, prior authorizations, and any other administrative needs submitted by patients following standard work determined by service line and answers any corresponding questions. Understands all documents and processes
• Documents detail each call in the patients' electronic medical record using both service line documentation tools as well in addition to free text when appropriate to ensure coordination of care
• Reviews and facilitates the updating of missing /outdated information in the patient record with each call including demographics, primary care physician selection, and insurance
• Effectively deescalates issues with upset patients and practices. Use advanced listening techniques to understand the issue and give patients options as they are available to help resolve and ensure satisfaction. May refer difficult or highly complex phone calls and issues to a supervisor
• Participates in resolving operational difficulties and communicate with supervisor regarding department issues/ problems and opportunities for improvement
• Develops and maintains effective and efficient communication with the patient, interdisciplinary team, department staff, providers, and other agencies
• Participates in problem solving activities, focusing on productivity and quality
• Works with supervisors to ensure continuous improvement of the department
• Attends required team and/or regional meetings to learn new workflows and stay connected with teams working in a remote environment
• Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations
• Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance
• Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents
• Writ