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 that can cause treatment safety issues and billing problems.
• Ensures compliance with accrediting bodies by using identifiers to positively identify a patient 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 responsibilities.
• Obtains accurate registration information to ensure timely payment and prevent billing issues and patient complaints.
• Maintains complete confidentiality of patient personal/financial information and medical records in accordance with HIPAA.
• Knows insurance basics, recognizes commercial and government plans, understands Advocate Health contracts, and determines when a statement of financial responsibility is needed.
• Discusses financial information and obligations with patients and knows when to refer patients to Financial Advocates.
• Ensures compliance with government regulations such as HIPAA, EMTALA, Consent for Treatment, Patient Rights and Responsibilities, IMM, MOON, Notice of Privacy Practices, MSPQ, ABN.
• Obtains patient or guarantor signatures as required.
• May schedule patient appointments and coordinate cancellations, reschedules, wait‑list requests, and recall requests.
• Provides accurate, detailed information regarding test preparations, arrival times, medication/food/beverage guidelines, check‑in procedures, and directions.
• Creates a welcoming, professional environment by delivering extraordinary customer service, greeting patients and visitors, and responding to routine information requests.
• Answers telephone calls, screens calls, and takes messages.
• Assists patients with transportation needs, directions, wheelchair location, interpreter services, etc.
• Monitors and works assigned electronic health record work queues following department processes.

Education & Licensure

High School Graduate required. No licensure, registration, or certification required.

Knowledge, Skills & Abilities

• Demonstrates Advocate Health purpose, values, and behaviors.
• Ability to work independently in a high‑profile, high‑stress environment, set and meet deadlines, multitask, and prioritize work.
• Handles large workloads with many interruptions in a fast‑paced setting without direct supervision.
• Strong attention to detail and accuracy.
• Excellent customer service and service‑recovery skills.
• Independent thinking, problem‑solving, and judgment to triage issues.
• Excellent written and verbal communication, interpersonal skills, and professional demeanor with patients, visitors, staff, and physicians.
• Educates patients on insurance coverage aspects of care and manages discussions about services that may not be paid by their health plan.
• Interacts with physicians and staff to resolve patient‑care issues.
• Collects and manages payments, including cash, and follows cash‑handling security procedures.
• Strong computer proficiency; experience with insurance verification/eligibility tools, EPIC EMR, patient liability estimation tools, email, Microsoft Office, internet browsers, and phone technology.
• Understanding of basic medical and insurance terminology used in scheduling and registration.
• HIPAA‑compliant and knowledgeable of applicable state and federal regulations.
• Ability to handle sensitive and confidential information according to internal policies.
• General understanding of health insurance: Medicare, Medicaid, managed care, and commercial payers.
• Ability to explain Medicare, HIPAA, EMTALA rules and stay current on insurance pre‑certification requirements.
• Excellent organizational skills and ability to act as a resource to other staff.

Physical Requirements & Working Conditions

This position may require travel and exposure to weather and road conditions. The role responds quickly to patient medical status and emergency situations in clerical areas. CPR certification may be required based on location; notary training/licensure may be required as appropriate. The employee operates necessary equipment, works in a normal office environment with significant patient and public contact, and may be exposed to ill or contagious patients. Physical demands include frequent transitions between sitting and standing, standing and sitting for extended periods, and mobility throughout the workday. Frequently lifts up to 10 lb and occasionally lifts 20 lb or more; may need to push/pull up to 50 lb with assistance when moving equipment, supplies, or transporting patients. Escorts patients to nursing units or outpatient departments as needed. Sensory requirements include vision, hearing, touch, clear speech, and fine‑motor skills for keyboard data entry. Flexible scheduling may be required to meet departmental needs.

Preferred Requirements

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