Service Representative Home Care Job

Children's Health - Service Representative Careers

Job Number: 50409

Location: Plano, TX

Date Posted: 1-3-2017


*NOTE: Department will be relocating to the Irving, TX area near DFW in June 2017.

Position Summary

Completes all central intake functions for the Home Care Department including taking patient referral information over the phone, verifying benefits and insurance eligibility, registering patient in the electronic system, inputting accurate referral data regarding patient's status in the system, tracking plan of care compliance, maintain expired authorization information, scheduling patient visits, and assisting patient families in navigating insurance benefit requirements. This position is accountable for delivering excellent customer service, obtaining accurate information, and maintaining a smooth intake workflow in the Home Care offices. Results expected are patient and provider satisfaction, in addition to complete, accurate data for appropriate financial outcomes.

Essential Duties

  • Referral Processing: Make initial contact with the patient family to verify location of home services and ensure all patient demographic information is correct. Register patient in electronic system with accurate patient demographic and insurance information. Verify benefits of patient to determine authorization requirements in order to access home care services. Maintain up-to-date Active Census List data based on regulatory standards. Ensures clinical information coincides with orders and obtained authorizations for services. Ensure smooth scheduling and authorizations workflow within the department.
  • Plan of Care Compliance: Obtain physician's signature on plan of care documents. Update Active Census List daily with information regarding status, comments, and plan of care frequency from documentation, as well as staffing changes. Contact physician office personnel in attempt to communicate needs to of the department, such as obtaining physician's signature on paperwork or processing new referrals. Ensure number of scheduled visits match authorized visits available to maintain plan of care compliance. Enter charges from completed visit information into electronic system when field staff needs assistance.
  • Insurance Authorizations: Verify third party coverage for all visits to ensure all services are reimbursed (through real time eligibility, using the internet or by phone to the payer). Understand the complexities of and complete all third party payment requirements by obtaining timely referrals and accurate authorizations within the required timelines. Request payments at the point of service when appropriate. Make appropriate referrals to financial counseling for uninsured and underinsured patients. Assist guarantors with questions related to the complexities of the healthcare reimbursement process.
  • Customer Service: Answer phone calls within four rings, obtain appropriate information, route calls as needed, research issues, and make adjustment to patient/staff schedules as needed. If bilingual will complete validation training through Language Access Services Department in order to interpret for staff and non-English speaking patients. Maintain Authorization Expiration Report to ensure patient re-assessments are completely timely and new authorizations are obtained in order to prevent breaks in home care services.



  • High school diploma or equivalent required
  • Two-year Associate's degree or equivalent experience preferred


  • Minimum 2-3 years of job related experience required
  • Data Processing/Keyboarding Skills required (30 wpm w/accuracy) required
  • Customer Service, Home Care scheduling or EPIC scheduling/registration experience preferred

Specific knowledge, skills, and abilities

  • Demonstrate strong customer service skills, preferably in healthcare or service industry.
  • Basic level proficiency in MS office, professional faxing software, and an Electronic Medical Record system
  • Familiarity with medical terminology and managed care concepts
  • Familiarity with regulatory requirements affecting patient access, insurance authorizations, and scheduling.
  • Ability to communicate with others in a clear, understandable, and professional manner on the phone and in person.
  • Flexibility and ability to adapt to rapid or frequent change while working on multiple projects and prioritizing tasks.
  • Demonstrated critical thinking and judgment as evidenced through the ability to independently identify and address issues and make decisions when appropriate.
  • Ability to build effective working relationships with all stakeholders in a manner that represents the values of CMC (peers, executive/medical staff, patient & families, vendors, insurance company representatives, etc)

Physical Demands

  • Light - Exerting up to 20 lbs. occasionally, 10 lbs. frequently, or negligible amounts constantly and may require walking or standing to a significant degree.

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