Oncology Patient Services Representative III

Organization:

SEBMF-East Bay Medical Foundation

Position Overview:

Serves as an advanced patient access resource and first point of contact for patients entering the outpatient facility. Greets and checks in patients, verifies demographic and insurance information, schedules appointments, updates the Electronic Health Record (EHR), and supports registration, consent, financial, healthcare, and insurance documentation. Performs advanced patient access functions including insurance verification, benefit review, referral coordination, prior authorization support, estimate preparation, and collection of patient financial responsibility. Coordinates complex scheduling needs and collaborates with clinical teams, authorization teams, and internal departments to reduce care delays and support timely access to services. Gains confidence and cooperation from patients, families/support persons, and healthcare providers through compassionate communication, competent job performance, and patient-centered service. Serves as a resource to patient services staff by supporting onboarding, answering workflow questions, reinforcing standard work, and assisting with resolution of complex or escalated patient access issues. Adheres to organizational, local, state, and federal regulations, codes, policies, and procedures to ensure privacy, safety, compliance, and optimal patient experience.

Job Description:

PATIENT SERVICES:

• Checks in patients and ensures all registrations, referrals, eligibility requirements, and necessary authorizations are complete or appropriately escalated prior to patient visits.
• Obtains and verifies patient demographic, medical history, referral, authorization, and insurance information to complete registration, financial, healthcare, and payer forms accurately.
• Communicates with patients in a clear and professional manner to alleviate confusion and expedite processes.
• Ensures that routine and priority tasks are completed within established departmental time frames.
• Applies advanced knowledge of insurance eligibility, benefits, referrals, prior authorization, medical necessity requirements, and patient liability to prepare estimates and communicate financial responsibility at point of service.
• Uses knowledge of medical terminology, services, diagnostic testing, surgeries, consultations, procedures, infusion-related visits, and follow-up care to support accurate scheduling and patient access workflows.
• Identifies complex patient access, scheduling, insurance, or authorization barriers and escalates issues to the appropriate department or leader to minimize delays in care.
• Serves as a department resource for patient services staff by answering workflow questions, supporting onboarding, reinforcing standard work, and assisting with complex or escalated patient access issues.
• Supports quality and process improvement by maintaining accurate registration, scheduling, authorization, and insurance documentation; identifying workflow gaps; and recommending improvements that enhance patient experience and front-end revenue cycle performance.

CLERICAL:

• Performs general clerical tasks, such as answering phones and greeting customers and patients.
• Prepares and completes accurate, job-related documentation, including collecting, updating, and maintaining patient medical and insurance information.

SCHEDULING SERVICES:

• Coordinates complex scheduling needs, including diagnostic testing, consultations, procedures, surgeries, infusion-related appointments, treatment-related visits, and follow-up care.
• Collaborates with clinical teams and internal departments to support timely, accurate, and patient-centered scheduling.

SAFETY:

Maintains a clean, neat, and safe working environment, including organizing files and keeping desks free of loose papers and clutter.

COMPLIANCE:

• Performs job responsibilities in compliance with department standards, policies, and procedures, and local, state and federal regulatory agencies to deliver the highest level of service.
• Maintains the strictest confidentiality of all patient protected health information (PHI) and protects all PHI from accidental, intentional, or inappropriate disclosure.

EDUCATION:

Equivalent experience will be accepted in lieu of the required degree or diploma.

HS Diploma or General Education Diploma (GED)

TYPICAL EXPERIENCE:

2 years recent relevant experience.

SKILLS AND KNOWLEDGE:

Intermediate to advanced knowledge of insurance policies and procedures, eligibility and benefit verification, referrals, prior authorization, patient estimates, collections, and patient billing.

Ability to interpret a variety of data and instructions, furnished in written, oral, diagram, or schedule form.

Possess written and verbal communications skills to communicate with fellow team members, supervisors, patients, and other personnel.

Ability to communicate complex scheduling, insurance, authorization, and financial information clearly and compassionately to patients and families, including individuals experiencing stress or barriers to care.

Ability to act as a workflow resource by supporting peers, reinforcing standard work, assisting with onboarding, and escalating complex issues appropriately.

Well-developed time management and organizational skills, including the ability to prioritize assignments and work within standardized policies and procedures to achieve objectives and meet deadlines.

General knowledge of computer applications, including Microsoft Office Suite, EHR, scheduling, registration, referral, authorization, billing systems, and payer portals.

Prioritize assignments and work within standardized policies and procedures to achieve objectives and meet deadlines.

Work independently, and be part of the team, including accomplishing multiple tasks in an environment with interruptions.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

Occasionally

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

Pay Range is $33.78 to $47.28 / hour

The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.