Patient Service Representative

Requirements

• High school diploma or GED required
• Patient access (scheduling, registration and financial clearance), insurance verification, billing, or certified medical assistant experience preferred

Responsibilities

• Greets patients arriving for their appointments
• Monitors patient flow to ensure patients are cared for in the most efficient and courteous manner
• Ensures all patient demographic and insurance information is complete and accurate
• Completes the registration process on walk-in patients, verifies and/or updates patient demographic and insurance information if changes or additions have occurred
• Verifies insurance benefits
• Obtains, calculates, and collects the patient’s out-of-pocket financial liability
• Requests and collects past due and present balances or estimates due
• Follows the Financial Clearance policy for non-urgent patient services if financial clearance has not been completed or authorization has not been obtained, when appropriate
• Identifies patients in need of financial assistance and refers patients to Financial Counselor
• Performs visit closure, including but not limited to checking out patients, scheduling follow-up appointment(s), collecting additional patient responsibility (when applicable), and providing patient with appropriate documents
• Maintains knowledge of and reference materials for Medicare, Medicaid, and third-party payer requirements, guidelines, and policies; insurance plans requiring pre-authorization/referral; and a list of current accepted insurance plans
• Proactively communicates issues involving customer service and process improvement opportunities to management
• Meets productivity requirements to ensure excellent service is provided to customers
• Meets or exceeds performance expectations of 98% accuracy rate and established department productivity measurements
• Maintains excellent public relations with patients, families, and clinical staff, demonstrating a willingness and ability to work collaboratively with others for concise and timely flow of information

Skills & Qualifications

• Ability to identify and understand issues and problems
• Examines data and draws logical conclusions based on information available
• Knowledge and ability to articulate explanations of Medicare, HIPAA, and EMTALA rules and regulations and comply with updates on insurance pre-certification requirements
• Mathematical aptitude, effective oral and written communication skills, and critical thinking skills
• Understanding of basic human anatomy, medical terminology, and procedures for application in the patient referral, pre-certification, and authorization processes
• Ability to speak effectively to customers or employees of the organization; presents a pleasant, professional demeanor and image during telephone conversation
• Ability to handle sensitive and confidential information according to internal policies
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
• Experience with Microsoft Outlook, Word, Excel, and ADT software
• Ability to write routine correspondence, calculate figures and amounts such as discounts and percentages
• Must be able to work with minimal supervision, problem-solve in a high-profile and high-stress area, and interact positively with all internal and external customers while possessing the ability to determine priority of work

Work Environment

Exposed to a normal office environment. Must be able to sit the majority of the workday. Occasionally lifts up to 10 lbs. Operates all equipment necessary to perform the job.