Patient Service Representative I Hospital

Responsibilities

• Creates the initial electronic health record that serves as the foundation of the patient medical record used by all members of the healthcare team.
• Prevents creation of duplicate medical records to avoid treatment safety issues and billing problems.
• Ensures compliance with organizational accrediting bodies by using identifiers to positively identify patients prior to care delivery.
• Checks in and registers patients; obtains and verifies complete demographic, guarantor, and insurance information.
• Discusses and collects co-pays and other out-of-pocket patient responsibilities to ensure timely payment and prevent billing issues.
• Maintains confidentiality of patient personal, financial, and medical records in accordance with HIPAA.
• Understands insurance basics, including commercial and government plans, and identifies contracted plans for Advocate Health.
• Discusses financial information and obligations with patients and knows when to refer them to Financial Advocates.
• Ensures compliance with government regulations, including HIPAA, EMTALA, Consent for Treatment, Medicare notices, and Advanced Beneficiary Notice (ABN).
• Obtains required patient or guarantor signatures.
• Schedules patient appointments, coordinates cancellations, reschedules, waitlist requests, and recalls.
• Provides detailed information regarding test preparations, arrival times, medication/food guidelines, check-in procedures, and facility directions.
• Creates a welcoming environment by demonstrating extraordinary customer service for patients and visitors.
• Greets patients and visitors, responds to routine requests, and answers/screens telephone calls.
• Assists patients with transportation, directions, wheelchairs, interpreter services, and other needs.
• Monitors and works assigned electronic health record work queues following department-approved processes.

Requirements

• High School Graduate (required).

Skills

• Demonstrates Advocate Health purpose, values, and behaviors.
• Ability to work independently in a high-stress, fast-paced environment with frequent interruptions and large workloads.
• Strong attention to detail, accuracy, and multitasking abilities.
• Excellent customer service and service recovery skills in various situations.
• Independent thinking, problem-solving, and judgment to triage issues.
• Strong communication (written and verbal), interpersonal, and professional demeanor.
• Ability to educate patients on insurance coverage, including managing discussions for services not covered by their health plan.
• Interacts with physicians and staff to resolve patient care issues.
• Collects and manages payments, including cash handling and security protocols.
• Proficient with computer systems, including insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, Microsoft Office, email, and phone technology.
• Understanding of basic medical and insurance terms, abbreviations, and compliance with HIPAA and other regulations.
• General knowledge of health insurance, including Medicare, Medicaid, managed care, and commercial payers.
• Ability to articulate explanations of Medicare, HIPAA, EMTALA rules, and insurance pre-certification requirements.
• Excellent organizational skills and ability to act as a resource for other staff.

Physical Requirements and Working Conditions

• May require travel and exposure to weather and road conditions.
• Responds quickly to patient medical status and emergencies in clerical areas.
• CPR certification may be required based on service location.
• Notary training/licensure may be required for specific service lines or facilities.
• Operates necessary office equipment and exposed to a normal office environment with significant patient and public contact.
• May be exposed to ill or contagious patients.
• Frequent transitions between sitting and standing; must be able to stand and sit for extended periods.
• Frequently lifts up to 10 lbs. and occasionally lifts 20 lbs. or more.
• Must be able to push/pull up to 50 lbs. with assistance (e.g., moving equipment or transporting patients).
• Escorts patients to nursing units or outpatient departments as necessary.
• Sensory requirements include vision, hearing, touch, and clear speech.
• Fine motor skills required for keyboard data entry.
• May be asked to work a flexible schedule to meet department needs.

Preferred Qualifications

• Experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, Microsoft Office, internet, and phone technology.

This job description indicates the general nature and level of work expected. It is not designed to cover all activities, duties, or responsibilities, which may be required of the incumbent.