Patient Service Representative

3 weeks ago

Downers Grove, United States Advocate Health Full time
Address: 2801 Finley St. Downers Grove, Office Hours: Monday- Thursday 7:30AM-&7PM, Friday 7:30AM-5PM, Sat 8-12pm rotating (every 5th Saturday when fully staffed)

Major Responsibilities:

  • Completes patient order confirmations and modifications for item changes occurring after initial order ticket printing to begin revenue recognition and billing processes.
    • 1)Reviews all paperwork submitted with equipment set up packets to ensure all forms are complete, signed and dated appropriately.
    • 2)Any safety issues documented by drivers will be followed up with appropriate correspondence to patients, physicians or management, such as patient smoking in the home with oxygen, incorrect storage of oxygen tanks, etc.
    • 3)Processes service maintenance tickets and resets the schedule for future service and maintenance of rental equipment.
    • 4)Maintain a knowledge of Medicare, Medicaid, HMO, Managed Care, PHO's and Advocate contract procedures and guidelines.
    • 5)Verify that current and appropriate authorizations are in place for all managed care clients for supplies and for purchased items.
    • 6)Identification, investigation and verification of sources of reimbursement.
    • 7)Be proficient in the use of computerized resources and data entry programs involving proper processing and qualifying of patients with clients with HME/RT needs. (These include, but are not limited to OnBase, Fastrack, Carenet, ERMA and Care Connection).
    • 8)Completes daily update by running the Confirmed Orders for Billing Report to identify and correct errors in order entry.
  • Completes Direct Bill entry for supply closet items dispensed at off site Advocate locations.
    • 1)Obtains payable diagnosis codes for item dispensed, using the Care Connection visit information, or as provided on the delivery transaction form.
    • 2)Reviews billing system to determine if patient has an existing account or creates a new account by entering demographic and insurance information.
    • 3)Completes insurance eligibility check within billing system for payers that system allows (BCBS, Medicare, Medicaid, HMOI).
    • 4)Enters charges through Direct Billing entry.
    • 5)Completes monthly bulk billing to hospital cost centers for Direct Bill items that were not billed to insurance due to payer being out-of-network with AHCP.
  • Works weekly Open Orders Report and investigates reason for delay in confirmation and revenue not being collected according to pre-defined process.
    • 1)Confirms or deletes open orders after thorough investigation and confirmation that service was provided.
  • Completes daily patient record retention and archive processes.
    • 1)Prepares all documents received during the confirmation process for scanning and indexing into the electronic medical record of the patient's account by removing staples, repairing tears, etc. according to pre-defined instructions.
    • 2)Operates and monitors scanning/imaging equipment.
    • 3)Reviews output copies to ensure and validate continuing resolution quality of printed images, informing management or IS Department if unable to correct faulty resolution issues.
    • 4)Indexes scanned documents by accurately selecting proper patient, document type and other descriptors.
    • 5)Storage and destruction of scanned documents per pre-defined instructions.
  • Prepares and works various reports in an effort to maintain accurate account information and status.
    • 1)Works monthly discharge reports to inactivate accounts with no active rentals and no activity in over one year.
    • 2)Works monthly Medicare Continued Use report for documentation of patients' use per Medicare guidelines.
    • 3)Follows up on lost/stolen equipment by sending letters to patients and facilities when equipment can not be retrieved.
  • Provides customer service support to both internal and external customers by resolving delivery, equipment, documentation and/or reimbursement issues with appropriate parties.
    • 1)Responds to customer equipment questions and refers to appropriate distribution associate and follows up to ensure resolution.
    • 2)Works with Intake and Distribution to answer questions concerning customer deliveries.
    • 3)Back up phone support for all AHCP departments, as well as assistance with walk-in patients.
  • Other duties as assigned by manager.
    • 1)Runs, collects and tabulates data and submits to management selected, assigned reports such as the Daily Order Report.


Education/Experience Required:

  • * High School Diploma * 3-4 years office experience. * Understanding of third party payors, including Medicare, Medicaid and private insurance companies. * Knowledge of medical terminology preferred. * Home care experience preferred.


Knowledge, Skills & Abilities Required:

  • * Strong Data Entry ability * Strong Organization Skills * Strong Detail Orientation * Strong Customer Service Skills * Able to work independently with minimal supervision
  • N/A


Physicial Requirements and Working Conditions:

  • N/A


This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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