PATIENT RESOURCE SPECIALIST

Overview

The Patient Resource Specialist is responsible for creating an excellent impression of Lincoln Memorial Hospital's resources to patients, families, and other external customers over the phone or in person. They work collaboratively with patients, providers, colleagues, and insurance companies to ensure that patient needs are met. The Patient Resource Specialist coordinates and participates in a variety of duties as part of the pre-visit process, including patient identification, pre-registration, pre-authorization, and appointment scheduling. They provide payment options, collect balances due, and initiate referrals for financial assistance per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established procedures. The role also requires maintaining up-to-date knowledge of Joint Commission standards, Patient Rights and Responsibilities, HIPAA compliance, and health system policies.

Qualifications

• Education: High school diploma or GED equivalent required.
• Experience: Two (2) years of business office experience, preferably in Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Previous experience in Patient Financial Services is highly desirable.
• Three (3+) years of customer service experience required.
• Medical terminology, medical office registration, or billing experience strongly preferred.
• CPSI/Evident systems experience preferred.

Responsibilities

• Assist customers and others regarding patient account issues, offering clear guidance and resolutions.
• Educate patients and others on billing resolution, private pay options, collection efforts, coordination of benefits, third-party and governmental payment criteria, insurance coverage, payments, and denials.
• Serve as a liaison between external resources, colleagues, and patients to ensure smooth communication and assistance.
• Demonstrate superior patient relations and interpersonal skills, maintaining a calm demeanor while dealing with patients, colleagues, and the general public.
• Use tact, sensitivity, and sound judgment to promote a positive work environment.
• Carefully coordinate accurate patient data collection to verify insurance eligibility and determine financial obligations, including collection of copayments and deductibles.
• Effectively negotiate with patients and families to explain, collect, and record patient payments and/or deposits, ensuring all information is entered accurately into electronic payment and patient accounting systems.
• Process and reconcile cash, checks, credit card transactions, and bank loans as appropriate, maintaining accuracy and security in the cash drawer.
• Prepare bank deposits for pickup in accordance with departmental procedures.
• Effectively triage, document, and initiate referrals for financial assistance, completing necessary paperwork or applications with MHS Patient Financial Services.
• Review and combine multiple financial accounts for individual patients.
• Explain available payment options and establish appropriate payment plans with patients or responsible parties per departmental guidelines.
• Research and resolve complex issues related to patient accounts, identifying and documenting problematic trends for management.
• Record all customer visits accurately, ensuring proactive discussion of all the patient’s accounts, noting and logging accounts according to departmental procedures.
• Document all collection activities thoroughly and send daily payment reconciliation reports to the appropriate teams within the MHS Finance Department.
• Identify, prioritize, and resolve problematic accounts by reviewing, investigating, and verifying patient eligibility for payer sources and/or financial assistance.
• Coordinate with various departments such as MHS Patient Financial Services, Patient Access, Case Management, Scheduling, and clinical departments to ensure accurate financial documentation and a consistent, interdisciplinary approach.
• Work with clinical departments to obtain insurance authorizations, verifications, and pre-certifications for outpatient services as needed.
• Build strong relationships with assigned business units, hospital departments, or provider offices, identifying and addressing trends in payment issues, educating and communicating with internal and external customers as appropriate.
• Complete all steps of pre-registration and registration, verifying patient identity and demographic information, ensuring insurance eligibility, and providing necessary patient information, including Advance Directive information.
• Orients and cross-trains other team members as directed by management.
• Understand and utilize all relevant computer systems related to job functions.
• May assist other areas within the unit or department during special needs or staff absences.
• Coordinate patient or family requests for records with Health Information Management (HIM).
• Perform other related work as required or requested.