Outpatient Service Rep

Responsibilities

• Schedules patients using the hospital's scheduling system.
• Schedules follow-up appointments using the on-line scheduling system.
• Schedules appointments for patients needing lab work, diagnostic imaging, or referral to other medical providers.
• Refers technical/clinical inquiries to appropriate personnel.
• Utilizes the on-line billing system to enter diagnosis/service codes from encounter sheets.
• Completes pre-registration and registration process using the on-line billing system.
• Verifies demographic data, insurance authorization information, co-pays, and physician information.
• Collects co-payments and provides patients with receipts.
• Produces registration cards using the on-line system and card embosser.
• Photocopies front and back of insurance card.
• Confirms patient eligibility with insurance carriers and obtains visit authorizations as necessary.
• Mails informational material to new patients in advance of scheduled appointments.
• Contacts agencies outside the Hospital to obtain pertinent patient information and to coordinate clinic/treatment programs.
• Contacts third party payors to obtain required pre-authorizations in accordance with established policies.
• Acts as an outpatient center receptionist.
• Makes telephone calls to patients as appointment reminders.
• Answers incoming calls.
• Returns phone calls to patients, physician offices, and other medical providers such as laboratory and radiology facilities.
• Greets arriving patients and verifies pertinent information and physician using the online billing system.
• Orients patients to the specific outpatient center as a hospital-based service.
• Interacts effectively with patients and their family members.
• Handles coding/billing within parameters as outlined in the department guideline.
• Enters diagnosis codes/service codes from encounter sheets using the on-line billing system.
• Verifies the appropriateness of the diagnostic code prior to entering in the billing system.
• Resolves billing issues, including denials, with patients and Patient Financial Services.
• Appropriately refers patients to patient advocate for financial counseling.
• Obtains and organizes medical records for use by physicians and nurses.
• Evaluates file prior to schedule visit and follows up with other Hospital departments to obtain missing data.
• Prints reports using both the online scheduling and billing systems.
• Performs all duties in accordance with RIH's mission, the defined role of ambulatory care, and defined administrative/clerical rules, procedures, and policies.
• May respond to telephone calls inquiries by rotating into a centralized setting (i.e., a call room).

Qualifications

• BASIC KNOWLEDGE:
• High School Diploma or equivalent.
• Demonstrated knowledge of PC skills using the windows operating system environment and accompanying software packages.
• Knowledge of medical billing routines for physician office practice.
• Knowledge of medical terminology, diagnosis codes, and procedure codes.
• Knowledge of courteous telephone technique and good customer service skills.
• EXPERIENCE:
• At least 6 months experience coding and billing using online billing system.

Work Environment and Physical Requirements

• Walking, sitting, standing throughout the day in clinic setting.

Independent Action

• Performs independently within department policies and practices.
• Refers specific complex problems to supervisor where clarification of departmental policies and procedures may be required.

Supervisory Responsibility

• None.