become a patient representative

What does a Patient Representative do?

A patient representative helps patients get the services they need, understand their health insurance policy, and help patients make more informed healthcare decisions. Those in this position may also be called patient navigators, patient service representatives, or patient advocates. They generally work at the location in which the patient is seeking care.

Watch a video to learn what a patient representative does.

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How to Become a Patient Representative

According to O*NET OnLine, around 35% of the patient representatives surveyed held a bachelor’s degree or higher, and all others have a minimum of a high school diploma. Most employers prefer extensive knowledge and experience in this career field; therefore, there are various avenues to enter this career field.

Some individuals decide to attend universities or community colleges that offer degrees or certification programs. These programs teach the necessary skills and are usually healthcare-related. Coursework includes patient care, anatomy, medical terminology, medical record software, insurance regulations compliance, and office administrative skills. Others decide to seek a certification such as a Certified Medical Assistant (CMA) or healthcare certification through the American Association of Medical Assistants (AAMA). This allows them to work with patients, therefore having a deeper understanding of all perspectives. Most companies will offer on-the-job training especially for learning their systems and medical policies, though prior experience is still necessary.

Looking for organizations or joining local patient advocacy groups may help as well. There are also national organizations such as the National Patient Advocate Foundation and the Alliance of Professional Health Advocates.

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What does a Patient Representative Do

A patient representative works in a variety of ways. Some work helping clients and their families get the appropriate healthcare necessary. They act as an advocate for the patient. This includes collaborating and communicating with other medical or administrative staff; therefore, active listening and customer service are required. They talk to insurance companies and the medical team to ask or change something a client requests or needs. Patient Representatives must remain calm under pressure. Consequently, this can be stressful when working with individuals who are not happy or frustrated with the healthcare services they are receiving.

Some patient representatives may work in offices or hospital settings. These representatives greet and check-in patients, verify insurance, and even direct patients to examination rooms. They also spend time on the phone, scheduling patient appointments, and making follow-up calls for upcoming meetings. They also communicate with insurance companies and medical staff to gather data needed to answer questions or complete paperwork.

Patient representatives should also know community resources available and recommend them to a patient- should additional help be needed. If there are issues that arise, they will also help communicate those issues with the appropriate medical staff to ensure their client receives the best care possible. Some patient representatives collect data on patient encounters and consumer satisfaction. They also represent patients at management and policy meetings to recommend reducing liability and improving health care quality.

Most patient representatives work full time and have regular hours. They usually work in an office setting and are in constant communication in person or on the phone. According to O*NET Online, there will be a growth in this career field, especially as the healthcare systems and insurances become more complex and challenging for consumers to navigate when seeking care.

Patient Representative Career Video Transcript

A patient representative is often the first face patients see when they enter a healthcare facility. Representatives help guide patients through the complex world of healthcare. Patient representatives are responsible for gathering background information from patients and informing them about the health resources available at the facility. They explain healthcare costs and may help patients determine how to pay for charges. Before patients leave, patient representatives help ensure they understand how their treatment will work, for example teaching patients to use equipment at home. They also collect and report data on patient encounters, handle patient inquiries, and train volunteers and staff. Working in healthcare facilities involves daily face-to-face interactions with patients.

Exposure to illnesses and bodily fluids can be a frequent occurrence, so following protocols to minimize health risks is a necessary part of the job. Patient representatives work schedules vary depending on the employer and patient load, from part-time hours to full time-plus. Typically, patient representatives need a bachelor’s degree, though some positions require only an associate’s degree.

Article Resources

National Center for O*NET Development. 43-4051.03. O*NET OnLine.

The video is Public Domain from the U. S. Department of Labor, Employment and Training Administration.