Patient Service Representative

Reports to the Manager or Director. Is responsible for the coordination of services for patients at the assigned clinic or site, which includes registration, admitting and discharging patients, scheduling of all new and existing patients, coordinating patients with providers' schedules, contacting payors for authorization/documentation/pre-certification, researching/gathering required outside patient records, and scheduling all ordered imaging and procedural appointments. Duties also include performing a variety of front office tasks, (i.e., greeting customers, answering the telephone, filing, etc.). Collects applicable co-payments and deductibles and completes insurance verification and must be able to accurately decipher eligibility responses and relay that information back to the patient.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Coordination of patient services at the assigned clinic or site by:

• Scheduling new patients upon physician referral and gathering outside records and imaging as needed with special attention to coordination of care according to disease site.
• Greeting patients upon arrival and accurately completing check in/registration process.
• Admitting and discharging patients, which includes discharging from computer system, completing chart audit form, discharging the patient chart.
• Communicating, verbally, electronically, or in writing with payors to ensure appropriate verification of services and payment.
• Completes check out process with patient after appointment which includes scheduling next appointment and/or scheduling coordinated imaging/procedures.
• Copying patient records and billing when appropriate for insurance companies, attorneys, subpoenas, patients, Vocational Rehabilitation and Disability Determination Board.
• Performing a variety of secretarial duties (i.e., typing, computer, greeting customers, answering the telephone, filing, etc.).
• Coordinating patient visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential.
• Answering high volume of incoming phone calls as well as making high volume of outbound phone calls, with constant communication to the dept clinical team, referring provider offices and Centralized Scheduling department.
• Properly triaging and/or handing incoming patient concerns / phone calls; making sure critical issues are addressed in a timely manner.

Registers patients (to obtain demographic, physician and insurance information in accordance with established departmental policies and procedures) and collects applicable co-payments and deductibles by:

• Interviewing patients via telephone for pre-admission or upon presentation for admission in the registration area.
• Obtaining identification, demographic, physician, and insurance information from patients and accurately entering this information into the Hospital financial system.
• Updates system after validation of the new patient's financial information.
• Explaining about the possible need to pre-certify with the patient's insurance carrier to ensure maximum coverage to the limits of the insured's insurance policy.
• Create patient estimate and requests payment either during the pre-registration process or when the patient presents for service in accordance with policies and procedures.
• After collecting applicable co-payments and deductibles, posting patient payments (including cash, checks and credit cards) on the patient's account and generating a system receipt to give to the patient.
• Verifying and documenting insurance coverage via online eligibility systems, internet resources or via telephone.
• Requesting copies of the insurance card(s) and driver's license or other government picture ID to confirm insurance benefits and identification.
• Validates medical necessity via the MCA Compliance Checker where applicable.
• Completing the MSP (Medicare Secondary Payor) questionnaire by asking the patient the questions based on pt availability.
• Requesting payment either during the pre-registration process, when the patient presents for service or at Patient Check Out in accordance with Beacon's policies and procedures.
• Referring the patient to the Financial Counselors or Eligibility Specialists if they are unable to secure satisfactory payment arrangements and have a self-pay balance of $500 or more. Also assisting in obtaining additional patient information, copies of insurance card(s) and church information.
• Obtaining all required signatures for the "consent to treat" and assignment of insurance benefits forms.
• Obtaining pre-certification information from the insurance company's pre-certification unit (i.e., whether pre-certification is required, if the ordering physician has completed it, etc.).
• When the ordering physician has not completed the pre-certification, calling the physician's office to initiate the pre-certification process, and following up until it has been completed.
• When the ordering physician has completed the pre-certification, documenting the authorization, and releasing the account.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Assisting the department to meet or exceed its quality assurance goals.
• Maintaining records, reports and files as required by departmental policies and procedures.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.
• Supporting the Director and Manager in the completion of special reports and/or department documentation and utilizing the Hospital computer system to run routine client service and demographic reports.

Education and Experience

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent); additional college-level business courses are preferred. Two to three years of progressively responsible experience in a related healthcare services environment is required.

Knowledge & Skills

• Requires a thorough knowledge of general office policies and procedures, secretarial functions, and outpatient clinical services.
• Demonstrates the interpersonal skills necessary to interact effectively with patients from various backgrounds in a professional, enthusiastic, courteous, friendly, caring, and sincere manner. Also demonstrates the ability to maintain effective working relationships with other departments, physicians, and their office staff.
• Requires effective telephone skills (for example, to accurately take and relay information about patients, physician orders and referrals).
• Demonstrates the ability to operate and effectively utilize a multiple line telephone system and the Hospital information system.
• Demonstrates well-developed communication skills, both verbal and written, needed to effectively interact with clients, staff, and third-party payers (both internal and external).
• Demonstrates knowledge of and a commitment to Beacon Health System's mission and values; and the organization's goal of providing exceptional patient experiences by following the Performance Essentials.
• Requires basic office and keyboarding skills (with the ability to type a minimum of 40 wpm) and the ability to use designated reference materials and office equipment (i.e., computer, printer, fax machine, calculator, etc.).
• Demonstrates proficient computer skills (i.e., data entry, word processing and spreadsheets). Requires the ability to use multiple databases (such as Pathways Healthcare Scheduling, RelayHealth, Cerner and PCA Compliance Checker).
• Requires a complete understanding of time-of-service collections. Specifically, must understand why it is necessary and must be able to effectively communicate this to Beacon's patient community as necessary.
• Requires basic knowledge of medical terminology, private insurance coverage (and managed care).
• Demonstrates the verbal communication skills needed to communicate in a clear and effective manner when conducting patient interviews, answering patients' questions and communicating with other departments and physician offices.
• Good listening skills are required. Sensitivity to individuals who do not speak English as their first language is expected.

Working Conditions

• Must be able to be effective in a busy, dynamic, and fast-paced office environment.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.

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