Patient Service Representative I Hospital

Major Responsibilities

• Perform all job duties in a way that conforms to customer service philosophy and consistent with AIDET standards:
  • Greet and acknowledge all patients and family members in a welcoming and prompt manner
  • Introduce the patient to services and what they can expect while under care; utilize appropriate etiquette in all communications
  • Provide the patient with information on likely time spent in service area (duration) including time in registration and time in clinical service
  • Explain nature of work, why demographic, socio-economic, and financial information is requested; explain how information is safeguarded and used to provide better care
  • Hand patients off to the next area with a clear "thank you"
• When creating new registrations for walk-in patients, identify insurance coverage, benefits available, patient out-of-pocket expenses, and collect co-insurance and co-payments
• Collect appropriate out of pocket expenses in accordance with policy
• Use electronic systems to confirm coverage while patient is present and discuss findings with patient; follow established department policies to resolve issues related to patient's eligibility for coverage or in-network status using Advocate's network
• When working uninsured patients, screen for urgent status cases and follow charity procedure; refer as appropriate for additional financial counseling; engage leaders to resolve questions on urgent versus non-urgent/elective care
• When assisting walk-in patients, screen orders for compliance with policy; work with physicians, Care Coordinators, and clinical department leaders to communicate and resolve issues related to order quality and acceptable standards
• Responsible for security authorization and precertification of inpatient and outpatient services
• Notify Financial Counseling, physicians, Care Coordinators, and Utilization Management on cases where patients are found to be uninsured, or where the only insurance is Third Party Liability or Workers Compensation
• Maintain knowledge of all stand-alone computer software programs to verify eligibility
• Identify at risk balances related to Medicare co-days, lifetime reserve days and other Medicare coverage limits and communicate to Financial Counseling, UM and physicians
• Identify at risk balances related to Medicaid eligibility rules and communicate to Financial Counseling, UM and physicians
• Initiate communication to patient when authorization is not obtained and explain potential financial impact and patient responsibility for unauthorized services
• Accurately collect and analyze clinical data in support of prior authorization and precertification as required by payor guidelines
• Acquire and maintain current knowledge of all insurance requirements as it relates to patient/hospital responsibility and hospital billing
• Stay current of all Federal and State regulations regarding billing
• Ensure completion of all established policies and procedures for identification and notification of the Primary Care Physician in the case of HMO coverage plans
• Inform Financial counseling, physicians, Care Coordinators and Utilization Management of out of network or noncovered service limitations of managed care/commercial insurance where benefits are at risk
• Responsible for pre-registration and registration accuracy
• Maintain knowledge of State & Federal regulations governing Medicare, Medicaid and Mental Health registrations
• Ensure accurate entry of patient demographic and insurance information in the ADT system with special attention to carrier code assignment, complete benefit, eligibility record and authorization data
• Pre-register and register patients using established procedures for computer entry for all ancillary and nursing units, keeping current with their specialized needs and preparing necessary documents/records when necessary
• During pre-registration or registration encounter, provide detailed education to the patient on contents of documents and forms requiring patient signature
• Manage incoming and outgoing calls to complete pre-registrations with patients
• Generate, assemble and process all required documents for completion of each registration
• Participate in departmental team building activities and in-services and other miscellaneous duties as assigned by leader
• Contribute to quality initiatives and mission by participating in team projects
• Attend all required departmental in-services to stay current of all job changes and responsibilities
• Assist leader in special assignments as may be needed to fulfill the mission of the department and the organization

Qualifications

• High School Diploma with 2 years of experience in either Patient Access or any of the following related experience: general physician office support or billing office, insurance office, hospitality, or call center (any industry)
• Intermediate math skills acquired through classroom work or through work experience
• Typing 25 WPM
• Basic understanding of web-based systems, proficiency in data entry

Schedule

• Full time, 40 hours per week
• Rotating schedule (3rd shift), 10p-8:30a
• Must be able to work a flexible schedule to support the needs of the department including evenings, weekends and holidays

Pay

• Pay range: $20.80 - $31.20

Benefits

• Benefits eligible
• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

Physical Requirements and Working Conditions

• Ability to prioritize and organize workload
• Sophisticated interviewing, communication and negotiation skills
• Independent decision making
• Ability to work as a team member
• Must be able to sit, stand, walk, lift, carry, squat, and bend frequently as well as twist, rotate, and kneel occasionally throughout the workday
• Frequently lifts up to 10 lbs. and occasionally lifts between 20 lbs. or more; occurs when moving equipment and supplies and when transporting patients and/or charts
• Must be able to push/pull up to 50 lbs. with assistance
• Must have functional speech and hearing
• Must be able to use hands with fine motor skills for keyboard data entry
• Exposed to a normal office environment
• Operates all equipment necessary to perform the job

Addendum: Offsite Imaging Centers

• Performs Computerized Provider Order Entry (CPOE) for exams accurately and completely to transcribe written physician orders; seeks clarification from technician and physician if needed
• Performs light duty cleaning of changing areas as needed
• Prints patient's results CDs when required and distributes finished exam results CD to patient while complying with applicable HIPAA considerations
• Escorts patients to changing areas as needed

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.