Outpatient Representative

Job Summary: The Outpatient Practice Management Representative performs centralized scheduling, admission/reception, insurance verification and initial financial screening functions necessary to assist patients to access and ensure appropriate funding for outpatient services provided by the Brattleboro Retreat.

Starting at $19.44 per hour

The Outpatient Practice Management Representative performs a variety of complex duties that will require collaboration with the referral/intake staff, clinical staff, patient financial services staff, insurance payers, providers and patients.

QUALIFICATIONS:

• Associates Degree in a related field is preferred. A high school diploma or equivalent (GED) is required.
• Customer service experience is required
• Previous admissions/registration/central scheduling experience is preferred
• Insurance verification experience required.

Admission/Reception/Check-out:

The Outpatient Representative is responsible for performing reception tasks for outpatient services and coordinate with clinical staff to transition patient to their scheduled appointment.

• Patient check-in -> Obtain/verify patient demographics, insurance info (Primary & Secondary); make updates in EHR
• Welcomes patients and visitors in person or by telephone, answers questions or inquiries, and provides assistance and directions, as needed
• Directing issues or potential issues to the designated administrator/provider
• Optimize patient satisfaction and facilitate patient flow by notifying the providers of patient's arrival, being aware of delays/no shows and communicating with patients and clinical staff
• Receives, directs and relays telephone, fax, email and patient portal messages
• Completes prescription refill requests including processing prior authorizations as needed.
• Manage welcome packets to ensure appropriate patient signatures are obtained that are required for Release of Information, Medicare forms (e.g., ABNs, MSPQ)
• Check-out process:
  • o Receive patient from clinical staff
  • o Collecting applicable co-pays and co-insurance payments
  • o Answer patient’s questions related to financial responsibility (e.g., outstanding balances, financial assistance guidance)
  • o Schedule next appointment
• Performs all other duties as trained and requested by provider and/or management

Insurance Verification:

The Outpatient Representative is responsible for the verification of a patient’s insurance eligibility and coverage, including prior authorization, for the various outpatient levels of care provided at the Brattleboro Retreat.

This includes, but not limited to, utilizing online eligibility websites, batch eligibility software and/or eligibility systems.

• Verify patient’s insurance eligibility for behavioral health services (onsite/telehealth), including any changes in insurance (i.e., new primary, secondary plans, loss of insurance, non-covered services, etc.)
• Contact patient’s insurance plan to obtain prior authorizations and referrals when necessary
• Contact patient to explains all current fees, financial responsibility and informs patient of payment required for existing balances due at or prior to next appointment.
• Contact patient to explain non-covered services.

Initial Financial Screening:

The Outpatient Representative will advise patients of self-pay requirements for outpatient services provided at the Brattleboro Retreat.

• True self-pay patients (no insurance) – refer to financial counselor to assist with Medicaid eligibility/application, financial assistance application or set-up payment plan options
• Non-covered services, benefits exhausted, etc

Centralized Scheduling/ Reminder calls:

• Responsible for scheduling calendar and contact patients for appointment reminders, schedule, re-schedule if cancelled or no-show
• Responsible for scheduling outpatient services from referral tracker
  1. Psychiatrist appointments
  2. Specialty Medicine clinic
  3. IOP/PHP
  4. AMBCC