Patient Services Representative

Inspire health. Serve with compassion. Be the difference.

Job Summary

Incumbents are responsible for aspects of Physician Practice front office management and operation as assigned. May be responsible for some or all front office functions as detailed in the next section.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health‘s values: Inspire health. Serve with compassion. Be the difference.

• Responsible for complete and accurate patient registration, pre-certification, charge capture and accurately coding diagnoses given by physicians. Responsible for posting all payments and balancing with the computer reports at day end. Requires a high level of public contact and excellent interpersonal skills. Arranges for patient pre-payments and enforces financial agreements prior to providing service. Gathers charge information, codes, enters into database, completes billing process, distributes billing information. Files insurance claims and assists patients in completing insurance forms. Processes unpaid accounts by contacting patients and third-party payers.

• Liaison between patient and medical support staff.Greets patients and visitors in a prompt, courteous, and helpful manner.Checks in patients, verifies and updates necessary insurance information in the patient accounting system.Obtains signatures on all forms and documents as required.Assists patients with ambulatory difficulties.Maintains appointment book and follows office scheduling policies.Provides front office phone support as needed and outlined throughcross trainingprogram.Screens visitors and responds to routine requests for information.Responsible for gathering, accurately coding and posting outpatient charges.Processes vouchers and private payments, to include updating registration screens based on information on checks.Research address verification as needed.Helps to process mail return statements and outgoing statements.Acquires billing information for all doctors for all patients seen in practice.Performs cashiering functions including monitoring and balancing cash drawer daily. Prepares daily cash deposits.Receives payments from patients and issues receipts. Codes and posts payments and maintains required records, reports and files.Works with patients in securing prepayment sources or financial agreements prior to providing service.Participates with other staff to achieve account resolution. Assists with outpatient coding and error resolution. Processes edits and Customer Service and Collection Request for resolution within specified time frames.Identify trends and communicates problems to management.Updates patient account database.Maintains and updates current information on physician‘s schedules.Schedules surgeries, ancillary services and follow-up outpatient appointments and admissions as requested.Answers questions regarding patient appointments and testing.Assembles patients‘ charts for next day visit.Updates profiles on all patients, ensuring completeness and accuracy.Oversees waiting area, coordinates patient movement, reports problems or irregularities.

• Assists patients with questions on insurance claims, obtaining disability insurance benefits, home health care, medical equipment, surgical care, etc. Processes benefit correspondence, signature, and insurance forms to expedite payment of outstanding claims.Assists patients in completing all necessary forms to obtain hospitalization or Surgical pre-certification from insurance companies.Follows-up with insurance companies ensuring that coverage is approved.Posts all actions and maintains permanent record of patient accounts.Answers patient questions and inquiries regarding their accounts.Confirms all workers‘ compensation claims with employees.Prepares disability claims in a timely manner.Follows-up with insurance companies ensuring that claims are paid as directed.Maintains files with referral slips, medical authorizations, and insurance slips.

• Researches all information needed to complete outpatient billing process including getting charge information from physicians.Codes information about procedures performed and diagnosis on charge.Keys charge information into on-line entry program. Processes and distributes copies of billings according to clinic policies.Assists with outpatient coding and error resolution.Pulls charts for scheduled appointments in advance.Delivers, transports, sorts and files returned charts.Picks up lab reports, dictations, X-rays, and correspondence.Continually checks for misfiled charts and refiles according to filing system. Maintains orderly files.Files all medical reports. Purges obsolete records and files in storage.Destroys outdated records following established procedures for retention and destruction.Makes up new patient charts. Repairs damaged charts. Assists in locating and filing records.Works with medical assistants and other staff to route patient charts to proper location.Follows medical records policies and procedures. -

• Collects payments at time of service for daily outpatient visit services.Reviews each account via computer to ensure patient‘s account(s) are being paid on a timely basis.Performs collection actions including contacting patients by telephone and resubmitting claims to third party reimburses.Evaluates patient financial status and establishes budget payment plans.Reviews accounts for possible assignment to collection agency, makes recommendation to Clinical Dept. Practice Manager.Identifies and resolves patient billing complaints.Participates with other staff to follow up on accounts until zero balance or turned over for collection. Participates in educational activities.Gathers and verifies superbills for specified practice on a daily basis.Enters all charge and same day payment information for patient visits and hospital patients, verifying accuracy of coding, charging and patient insurance status.Prints daily reports, verifying charge entry balancing at day end.Backs up and closes computer files on a daily basis, logging as appropriate (i.e. closing all batches in accordance with policy).Registers new patients after verifying patient status on computer inquiry. Updates financial information as indicated. Maintains strictest confidentiality.Participates in educational activities.Performs related work as required.As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. -

• Performs other duties as assigned.

Supervisory/Management Responsibility

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR Post-high school diploma. Associate degree in technical specialty program of 18 months minimum in length preferred

• Experience - No previous experience required. Multi-specialty group practice setting experience - Preferred

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• Basic understanding of ICD-9 and CPT coding- Preferred

Work Shift

Day (United States of America)

Location

100 N Sumter St Sumter

Facility

3420 Orthopedics Sumter

Department

34201000 Orthopedics Sumter-Practice Operations

Share your talent with us Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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