Patient Service Representative

Responsibilities

• Greets and checks in patients arriving for their appointments.
• Ensures patient information is complete and accurate.
• Collects patient responsibility as identified in the pre‑registration process.
• 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 patient responsibility and requests payment; communicates to the patient the organization’s expectation of payment at time of service.
• Identifies patients in need of financial assistance and refers them to a Financial Advocate when necessary; collaborates with the Financial Advocate to coordinate the patient’s financial resources and responsibilities, including requesting the patient sign a Financial Obligation Form (FOF) or Advanced Beneficiary Notice (ABN) as needed.
• Monitors patient flow to ensure patients are cared for in the most efficient and courteous manner.
• Performs visit closure, including checking out patients, collecting additional patient responsibility (when applicable) and providing the patient with appropriate documents.
• Schedules patient visits using guidelines established within the scheduling system.
• Assists with new caregiver onboarding.
• Works assigned EPIC work queues, following the department’s workflow process.
• Maintains excellent public relations with patients, families, and clinical staff; demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information and proactively communicates customer‑service issues and process‑improvement opportunities to management.
• 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 currently accepted insurance plans.

Licensure / Certification

None Required.

Education

High School Graduate.

Experience

Typically requires 1 year of experience in customer service or clerical/office work, including answering phones and assisting customers.

Knowledge, Skills & Abilities

• Demonstrated 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 to comply with updates on insurance pre‑certification requirements.
• Mathematical aptitude, effective communication skills, and critical thinking skills.
• Understanding of basic human anatomy, medical terminology, and procedures for application in patient referral, pre‑certification, and authorization processes.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to speak effectively to customers or employees, maintaining a pleasant, professional demeanor.
• Ability to handle sensitive and confidential information according to internal policies.
• Ability to problem‑solve in a high‑profile, high‑stress environment, working independently to set and meet deadlines and prioritize work.
• Demonstrated technical proficiency, including experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer, and phone technology.

Physical Requirements & Working Conditions

• Must be able to sit, stand, walk, lift, carry, squat, and bend frequently; twist, rotate, and kneel occasionally throughout the workday.
• Frequently lifts up to 10 lb.; occasionally lifts 20 lb. or more when moving equipment, supplies, or transporting patients/charts.
• Must be able to push/pull up to 50 lb. with assistance.
• Functional speech and hearing required.
• Fine‑motor hand skills needed for keyboard data entry.
• Exposed to a normal office environment and operates all equipment necessary to perform the job.
• Must be able to work a flexible schedule to support departmental needs.