Patient Service Representative I Hospital

Schedule

PRN – Variable, flexible, day shift, evening, and overnight.

Pay

$20.80 – $31.20 per hour.

About the role

Performs all job duties in a way that conforms to customer-service philosophy and AIDET standards.

Responsibilities

• Greet and acknowledge all patients and family members promptly and courteously.
• Introduce services, expected duration, and registration/clinical workflow; use appropriate etiquette in all communications.
• Explain the purpose of demographic, socio-economic, and financial information; describe how data is safeguarded and used to improve care.
• Hand patients off to the next area with a clear “thank you.”
• For walk-in patients, identify insurance coverage, available benefits, patient out-of-pocket expenses, and collect co-pays/co-insurance.
• Use electronic systems to confirm coverage while the patient is present; discuss findings and resolve eligibility issues per department policy.
• Screen uninsured patients for urgent status and follow charity-care procedures; refer to financial counseling as needed.
• Screen orders for compliance; work with physicians, care coordinators, and clinical leaders to resolve order-quality issues.
• Perform security authorization and precertification for inpatient and outpatient services.
• Notify financial counseling, physicians, care coordinators, and utilization management when patients are uninsured or covered only by third-party liability or workers compensation.
• Maintain knowledge of software used to verify eligibility.
• Identify at-risk balances related to Medicare co-days, lifetime reserve days, Medicaid eligibility rules, and other coverage limits; communicate to financial counseling, UM, and physicians.
• Initiate patient communication when authorization is not obtained; explain potential financial impact and patient responsibility.
• Accurately collect and analyze clinical data to support prior authorization and precertification per payor guidelines.
• Acquire and maintain current knowledge of insurance requirements and federal/state billing regulations.
• Ensure completion of policies and procedures for notifying the primary care physician in HMO plans.
• Inform financial counseling, physicians, care coordinators, and utilization management of out-of-network or non-covered service limitations in managed-care/commercial plans.
• Pre-register and register patients accurately; ensure correct entry of demographic and insurance data in the ADT system, including carrier code assignment and complete benefit/eligibility records.
• Pre-register and register patients for all ancillary and nursing units; prepare necessary documents and records.
• During pre-registration or registration, educate patients on the contents of documents requiring signature.
• Manage incoming and outgoing calls to complete pre-registrations.
• Generate, assemble, and process all required registration documents.
• Participate in team-building activities, in-services, and other duties as assigned.
• Contribute to quality initiatives and the department’s mission through team projects.
• Attend required in-services to stay current with job changes and responsibilities.
• Assist leadership with special assignments to fulfill the department’s and organization’s mission.
• At offsite imaging centers, perform additional activities including:
  • Accurately perform Computerized Provider Order Entry (CPOE) for exams; seek clarification from technicians or physicians when needed.
  • Perform light-duty cleaning of changing areas as required.
  • Print and distribute patient exam-result CDs while complying with HIPAA.
  • Escort patients to changing areas as needed.

Requirements

• High school diploma.
• 2 years of experience in Patient Access or related roles (general physician-office support, billing office, insurance office, hospitality, or call center).
• Intermediate math skills acquired through classroom work or experience.

Qualifications

• Typing 25 WPM.
• Basic understanding of web-based systems and proficiency in data entry.

Knowledge, Skills & Abilities

• Sophisticated interviewing, communication, and negotiation skills.
• Independent decision-making ability.
• Ability to prioritize and organize workload.
• Ability to work flexible hours, including evenings, weekends, and holidays.
• Ability to work effectively as a team member.

Physical Requirements

• Ability to sit, stand, walk, lift, carry, squat, bend, twist, rotate, and kneel frequently to occasionally throughout the workday.
• Frequently lifts up to 10 lbs.; occasionally lifts 20 lbs. or more when moving equipment/supplies or transporting patients and/or charts.
• Must be able to push/pull up to 50 lbs. with assistance.
• Functional speech and hearing; fine-motor skills for keyboard data entry.