Patient Service Representative I

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.
• 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; 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; demonstrates willingness and ability to work collaboratively with others for concise and timely flow of information.

Qualifications

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

Licensure, Registration, and/or Certification: None required.

Work Experience: None required.

Skills

• 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 conversations.
• 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.
• Ability to work with minimal supervision, problem-solve in a high-profile and high-stress area, interact positively with all internal and external customers, and determine priority of work.

Physical Requirements

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