Outpatient Services Rep

About the role

Under general supervision and according to established policies and procedures, the incumbent performs administrative duties to expedite patient visits for clinical care, including preparation of patient records; registration and pre-registration; problem resolution; appointment scheduling; and co-payment preparation and collection. Ancillary duties involve tracking and status of follow-up care related to diagnostic coding, billing/payment resolution, and generating system reports reflecting scheduling activities. Employees are expected to role model Brown University Health’s values of Compassion, Accountability, Respect, and Excellence and demonstrate core success factors such as instilling trust, valuing differences, patient and community focus, and collaboration.

Responsibilities

• Schedules patients using the hospital’s scheduling system, including appointment type, provider clinic, and time; schedules follow-ups and may arrange lab work, diagnostic imaging, or referrals to other providers.
• Refers technical or clinical inquiries to appropriate personnel.
• Enters diagnosis/service codes from encounter sheets into the online billing system, verifying code appropriateness before entry.
• Completes pre-registration and registration using the online billing system; verifies demographic data, insurance authorization, co-pays, and physician; collects co-payments and issues receipts; produces registration cards and photocopies insurance cards.
• Confirms patient eligibility with insurers and obtains visit authorizations as required.
• Provides mature, quality customer service to patients, families, and representatives; mails informational materials to new patients; contacts external agencies to obtain patient information and coordinate treatment programs; contacts third-party payors for pre-authorizations.
• Acts as outpatient center receptionist: answers and returns calls, makes appointment reminders, greets patients, verifies information and physician via the online billing system, orients patients to the outpatient center, and interacts effectively with patients and families.
• Handles coding/billing within department guidelines; resolves billing issues and denials; refers patients to financial counseling as appropriate.
• Obtains and organizes medical records for physicians and nurses; ensures files are complete with labs, test results, and x-rays; follows up with departments to obtain missing data.
• Prints reports using the online scheduling and billing systems.
• Performs duties in accordance with Rhode Island Hospital’s mission, ambulatory care role, and defined administrative/clerical policies and procedures.
• May respond to telephone inquiries by rotating into a centralized call room.

Minimum Qualifications

• High School Diploma or equivalent.
• Demonstrated PC skills using Windows and common software packages.
• Knowledge of medical billing routines for physician office practice.
• Knowledge of medical terminology, diagnosis codes, and procedure codes.
• Proficiency in courteous telephone technique and strong customer service skills.
• Six months of experience coding and billing using an online billing system.

Work Environment and Physical Requirements

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