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Business Service Representative

4 months ago

San Diego, United States Sharp Healthcare Full time

[H.S. Diploma or Equivalent
**Hours**:
**Shift Start Time**:
Variable
**Shift End Time**:
Variable

**AWS Hours Requirement**:
**Additional Shift Information**:
**Weekend Requirements**:
As Needed

**On-Call Required**:
No

**Hourly Pay Range (Minimum - Midpoint - Maximum)**:
$23.100 - $28.514 - $34.217

**What You Will Do**
The Business Service Representative coordinates all registration functions necessary to ensure the processing of a clean claim including but not limited to obtaining and processing patient demographics, visit and financial information in a manner that facilitates maximum financial reimbursement and promotes outstanding customer service. The Business Service Representative ensures that each billing inquiry has outcome resolution in a timely manner and appropriate parties are informed.

**Required Qualifications**
- H.S. Diploma or Equivalent
- 2 Years experience in Business Office, Medical Insurance Billing or Scheduling Systems.

**Preferred Qualifications**
- Coursework in medical terminology

**Essential Functions**
- Patient Registration
Authenticate and/or enroll patient at workstations where Patient Secure palm scanner is available. Follow established guidelines such as scripting and picture identification for enrollment and authentication. In absence of Patient Secure at workstation, use at least two patient identifiers to confirm patient identity. Notify MPI-DUPREG, document potential duplicate, and overlap registration when identified.
Populate all demographic screens for new and established patients. Follow demographic establish guidelines.
Complete regulatory required fields in demographic data with patient choices on regulatory forms such as Notice of Privacy Practice (NPP) and Advance Directives (ADHC).
Secure patient signature on Condition of Registration (COR) and update date field in registration screen.
Request and input Primary Care Provider (PCP) in demographic field.
Provide New Patients with required information to Sharp Rees-Stealy (SRS) and resources to services.
Registrations are 90% completed prior to services rendered.
Promote Sharp Rees-Stealy self-service technology.
- Patient Insurance
Completes verification using online platforms (i.e. MPV Experian and insurance portals) as appropriate and/or utilizes telephone system to complete.
Financial Status Classification (FSC) added to system accurately following department guidelines.
Communicate eligibility concerns to patients and provide solutions as appropriate.
Utilizes ARR system and other on-line request systems to update insurance dictionaries.
Verifies invoices and makes necessary adjustments following department guidelines.
Ensure documentation is clear and precise with patient communication or other concerns.
- Insurance Authorization
Obtains authorization as needed for clinics or special procedures.
Monitors authorizations for insurance changes and resubmits authorization as needed.
Communicates benefits for procedures and medical necessity requirements to clinical teams and/or physicians.
Assist with retro-authorizations on services rendered as needed.
Reviews and obtains vision authorization for billing and follows department guidelines.
Insurance authorization number is recorded accurately in the appointment visit data form (VDF).
Utilizes insurance authorization online portals as needed.
- Financial Collections
Provide estimates using price estimator.
Request payment of co-pay, deductible, estimated out-of-pocket or good faith deposit as specified in department guidelines.
Collect self-pay procedures and non-covered services following department guidelines.
Provides patients with financial counseling and negotiates in a positive manner to collect open balances following department guidelines.
Receive and post funds/credit card payments to correct invoices.
Complete daily reconciliation balancing of payments of cash drawer following department guidelines.
- Customer Service
Use AIDET, key words at key times, on-stage behavior to contribute above 90th percentile on patient satisfaction.
Displays empathy with patients under stressful situations and with frequent interruptions.
Avoids jargon when communicating with patients.
Adapt and protect patient privacy as needed (i.e. lowering voice, using face sheets vs verbal interviews depending on workstation setting).
Practice good interpersonal and communication skills and ability to work well with others contributing to a team environment.
Practice a positive and constructive attitude at all times.
Perform service recovery when The Sharp Experience does not go right in accordance to Sharp’s Behavior Standard Service Recovery.
Ability to problem-solve, work independently and ability to escalate patient accounts.
Communicates effectively both orally and in writing sufficient to perform essential job functions.
- Demonstrates initiative and teamwork
Prioritize job responsibilities effectively and informs leadership of backlog or slow volumes. Assists other ar