Patient Experience Representative

Patient Experience Representative

Department/Care Stream: Patient Services

LIA Reporting Structure

Timecard Approver: Patient Experience Supervisor

Primary: Patient Experience Supervisor  

Secondary: Patient Services Manager

Status: Full-Time

FLSA: Non-Exempt

Location: Rancho Cordova Center

Pay Range: $24.90-$32.37/hr

EEO-1: Office and Clerical

Organization Information

WellSpace's mission is "achieving regional health through high quality comprehensive care." We believe that everyone deserves to be seen, no matter who you are, where you come from, where you work or what place you call home. At WellSpace, we see you!  

We are driven to serve the whole person through comprehensive, integrated care, spanning medical, dental, behavioral health, and supportive services across the region. We do this by building a team of exceptional colleagues who are dedicated to our mission and becoming part of the communities we serve. 

As the region's largest Community Health System, WellSpace utilizes a Confluence Model to integrate an internal network of healthcare modalities, including Federally Qualified Health Centers (FQHC), Certified Community Behavioral Health Center (CCBHC), Drug Medi-Cal and Specialty Mental Health programs, California's second largest 988 Suicide and Crisis Lifeline Center, an independent Risk Bearing Organization (WellSpace Nexus), and more into a seamless confluence of care.

To ensure the highest quality of care, WellSpace is accredited by the Joint Commission for Ambulatory Care, Behavioral Health and as a CCBHC. Further, it is certified by the Joint Commission as a Primary Care Medical Home and a Behavioral Health Home. WellSpace's crisis programs are accredited by the American Association of Suicidology and the International Council for Helplines. 

Position Summary

The Patient Experience Representative is responsible for all administrative functions to support the Office of Patient Experience in accordance with established policies and procedures. Administrative functions include but are not limited to the documentation, research and resolution of grievances, comments, concerns, website email, “we listen” and social media reviews as presented by patients or their authorized representatives, contracted Health Plans and providers. This individual will have a strong work ethic, excellent relational skills, is self-directed, and enjoys working in a fast-paced environment.

Required Qualifications

• High School graduate, some college preferred OR an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job.
• Excellent customer service experience including active listening, problem solving, and the ability to remain calm in emotional or stressful situations.
• Demonstrated commitment to the provision of services for the underserved and sensitivity working with a variety of people from low-income populations, with diverse educational, lifestyle, ethnic, and cultural origins; disabled, homeless, substance users, HIV (AIDS) infected, and/or physiologically impaired.
• Establish and maintain positive, professional relationships.
• Ability to perform administrative tasks which includes, but is not limited to communication, technology, organization, planning and problem-solving;
• Prioritize, organize and execute tasks in a changing environment.
• Ability to maintain detailed records.
• Computer (PC) literate in Microsoft Word, Excel, Powerpoint, Outlook email and database software.
• Ability to use standard office equipment including phone, fax, copier, computer.
• Knowledge of state funding sources preferred.
• Able to take and follow through with delegated tasks and accountability.
• Fluency in additional languages preferred.
• Communicate clearly and concisely, both verbally and in writing and demonstrate a high level of listening skills.
• Commitment to HIPAA and ability to abide by standards of professional ethics and maintain confidentiality.
• Adherence to infection control procedures, including but not limited to, standard precautions of temperature monitoring, hand washing, symptom self-monitoring, masking and social distancing.
• Assist and support the Center/Department/Program to meet standards of High Reliability.

Responsibilities

• Analyze, research, resolve and respond to complaints, grievances, comment forms, website email, “we listen” and social media reviews from patients, providers, and regulatory agencies with established regulatory and accreditation guidelines.
• Prepare summaries and write resolution letters for Health Plans, which include summarizing patient’s grievances and steps taken to resolve complaints in clear and grammatically correct language.
• Provide comprehensive grievances responses that support the decision and comply with regulatory and accreditation guidelines within regulatory timeliness.
• Contact patient by phone as appropriate to reach a positive resolution.
• Stay abreast of internal policies, procedures and regulations for accurate resolution of grievances.
• Identify business problems and servicing issues and direct to the appropriate area for action.
• Work closely with the Health Centers to ensure performance goals are met.
• Understand the organization and help navigate patients through it.
• Provide superior customer service to internal/external customers to ensure an exceptional customer experience.
• Answer telephone calls and email inquiries regarding grievances, comment forms, website email, “we listen and social medial reviews while maintaining a professional level of telephone and email etiquette at all times.
• Take messages and route calls as appropriate.
• Properly identify and verify patients and clients eligibility.
• Educate patients on the grievance process and direct them to their assigned health plan when appropriate.
• Utilize strong judgement to identify if a grievance, question or concern has clinical components and requires clinical team for handling.
• Prepare and maintain individual file folder for all cases received to include a check list and documents related to the cases.
• Maintain all case files organized properly in the department electronic files.
• Conduct follow up activities to ensure a response is obtained by the due date to remain in compliance.
• Interface with contracted health plans to request missing information such as a provider’s name, date of service, location, etc.
• Conduct relevant case research in all available systems (NextGen, Ytel, etc.)
• Ensure all cases are handled and resolved in compliance with timeline requirements and the highest standards for accuracy.
• Maintain confidentiality of all protected health information in accordance with the organization guidelines.
• Identify barriers to customer satisfaction and timely case response and recommend actions to address operational challenges.
• Manage large volumes of documents including copying, faxing and scanning.
• Act as a patient liaison responsible for assisting patients with questions to resolve concerns and improve services.
• Analyze all concerns, identify trends and make recommendations.
• Understand the organization and help navigate patients through it.
• Maintain office appearance on a daily basis.
• Schedule appointments.
• Copy and shred as indicated.
• Provide equipment maintenance on a back-up basis.
• Provide general administrative support (i.e. typing, filing, etc.).
• Actively participate in all departmental meetings, training sessions, and other activities.
• Performs other tasks as assigned.

Benefits

Successful candidate will receive regionally competitive salary, above average health benefits at reduced costs, company paid life insurance & long-term disability insurance, additional voluntary retirement plan with company match and no vesting schedule requirement.

• Paid bereavement and jury duty leave
• 11 paid holidays per year
• Paid time off
• Paid sick leave
• Flexible Spending Program
• Company paid malpractice insurance for all providers
• Professional development hours offered annually

Physical Demands and Work Environment

The work environment is characteristic of a medical clinic environment. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit; use hands to handle, or feel. The employee is also required to stand; walk; and reach with hands and arms. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, and the ability to adjust focus. The employee must also possess hearing and speech to communicate in person and over the phone. The noise level in the work environment is usually quiet.

The employee may be in contact with individuals and families in crisis who may be ill, using substances and/or not attentive to personal health and safety for themselves or their homes. The employee may experience a number of unpleasant sensory demands associated with the client’s use of alcohol and drugs, and the lack of personal care. The employee may also be exposed to bodily fluids (blood, urine) and hazardous chemicals.

WellSpace Health is committed to the principals of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is the intent of WellSpace Health to maintain a work environment free of harassment, discrimination, or retaliation because of age, race, religious creed, color, national origin, ancestry, physical disability, medical condition, genetic information, marital status, sex (including pregnancy, childbirth, breastfeeding and/or related medical conditions), gender, gender identity, gender expression, sexual orientation, military or veteran status, or any other status protected by federal, state or local laws.  WellSpace Health is dedicated to the fulfillment of this policy in regard to all aspects of employment, including but not limited to recruiting, hiring, placement transfer, training, promotion, rates of pay, and other compensation, termination, and all other terms, conditions, and privileges of employment.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WellSpace Health is an Equal Opportunity Employer

Salary : $25 - $32