Patient Services Representative Team Lead

Data Hire, LLC

All cities,CA


Job Summary

Job Summary

Provides training, coaching and daily direction to a team of Patient Service Representatives. Supports team in researching and completing incomplete authorizations, reviewing medical documentation to satisfy invoicing requirements and obtaining missing medical documentation. Places outbound calls and receives calls to schedule Veterans appointments. Directly interacts with a variety of customers daily. Provides back-up by phone to facilitate patient transfers as requested by VA. Works in a detailed, multi-tasked and fast-paced production environment.

Government Reporting


Education & Experience


o High School diploma or G.E.D.
o At least one full year experience working in a call center and/or medical appointing in a medical office.
o Proficient with Microsoft Outlook and the internet

Knowledge of medical terminology normally obtained through a medical certification OR work experience using and understanding ICD and CPT codes

Proficiency using CareRadius


Associates degree in healthcare or related field

Previous Team Lead experience

Key Responsibilities

Key Responsibilities

  • Works with leadership to escalate issues to the appropriate department
    o Serves as a Subject Matter Expert to Patient Service Representatives o Investigates recurring problems for process improvements and reports on findings.
    o Assists leadership in distributing/adjusting Patient Service Representative workload based on work volume.
    o Maintains updated knowledge of software applications, on-line system, Patient Service Representative procedures and processes.

    o Assists Patient Service Representatives Supervisors and management in tracking daily performance statistics.
    o Manages multiple tasks lists in accordance within directed timelines.
    o Complies with HIPAA regulations to protect privacy of beneficiaries' health information.
    o Documents all communications involving Veteran and provider contacts.
    o Coordinates complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialist and other departments when requested.
    o Consistently meets department productivity and performance metrics.
    o Performs other duties as assigned.
    o Regular and reliable attendance is required.
  • .. o Schedules appointments for Veterans using the medical management appointing function for specialty care in the provider network in accordance with VA guidelines and TriWest desk procedures.
    o Responds to inquiries from Veterans and providers regarding specific aspects of the VA program. Information and assistance includes providing details about referrals, authorizations, and the location and use of network providers and when necessary redirect to the VA for further healthcare services.
  • Competencies

    Technical Skills

    Knowledge of TRICARE policies, processes, and procedures, knowledge of call management methodology, proficient with all three Customer Service Representative Skill Sets

    Team-Building / Team Player

    Influence the actions and opinions of others in a positive direction and build group commitment.

    Problem Solving / Analysis

    Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.

    Organizational Skills

    Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

    Multi-Tasking / Time Management

    Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

    Information Management

    Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

    Independent Thinking / Self-Initiative

    Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.

    High Intensity Environment

    Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

    Coping / Flexibility

    Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

    Computer Literacy

    Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

    Communication / People Skills

    Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

    Coaching / Training / Mentoring

    Actively foster actions required for desired business outcomes through ongoing constructive feedback.

    Working Conditions

    Working Conditions

    o Ability to cover any work shift with no travel
    o Works within a standard office environment
    o Extensive computer work with prolonged sitting and wearing of headset
    o VA-approved security clearance may be required

  • ** This job description indicates the general nature and levels of work expected of the incumbents. It is not designed to cover or contain a comprehensive listing of activities, duties, responsibilities or competencies required of an incumbent. Incumbents may be asked to perform other duties as required. **

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