Patient Service Representative I Med Grp

Major Responsibilities

• Creates the initial electronic health record that serves as the foundation of the patient medical record utilized by all members of the healthcare team.
• Prevents creation of duplicate medical records that can cause treatment safety issues and billing problems.
• Follows and ensures compliance with the mandate of the organization's accrediting bodies to use identifiers to positively identify a patient prior to the delivery of patient care to ensure patient safety.
• 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.
• Obtains accurate information at the point of registration to help ensure timely payment to the organization and prevent billing issues and patient complaints.
• Maintains complete confidentiality regarding patient personal/financial information and medical records in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
• Knows insurance basics and recognizes commercial and government plans.
• Understands which plans AAH contracts with and when a statement of financial responsibility is needed.
• Understands and discusses financial information and obligations with patients.
• Knows how and when to refer patients to Financial Advocates.
• Has knowledge of which rules, forms, and questions must be enforced to ensure AAH remains compliant with government agencies and regulations (e.g., HIPAA, EMTALA, Consent for Treatment, Patient Rights and Responsibilities, Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), Notice of Privacy Practices, Medicare Secondary Payer Questionnaire (MSPQ), Advanced Beneficiary Notice (ABN)).
• Obtains patient or guarantor signatures as required.
• May schedule patient appointments, including virtual and procedural; may also coordinate cancellations, reschedules, wait list requests, and recall requests.
• May provide accurate, detailed information regarding test preparations, patient arrival time, medication/food/beverage consumption guidelines, check-in procedures, directions to facility, etc.
• May perform visit closure, including checking out patients after their visit, scheduling follow-up appointment(s), and providing patients with the after-visit summary.
• May educate and support patients with the patient portal/app.
• Creates a welcoming and professional environment for patients and visitors by demonstrating extraordinary customer service.
• Greets patients and visitors and responds to routine requests for information.
• Answers telephone, screens calls, and takes messages.
• Maintains excellent public relations with patients, families, and clinical staff; demonstrates willingness and ability to work collaboratively for concise and timely flow of information.
• Proactively communicates issues involving customer service and process improvement opportunities to management.
• Offers various assistance to patients, including arranging transportation needs, providing directions, locating a wheelchair, coordinating interpreter services, etc.
• May be responsible for e-scanning documents to Health Information Management (HIM), addressing incoming/outgoing fax, addressing inbasket messages via the electronic health record, and following direction from the clinical team for emergent needs.
• Monitors and works assigned electronic health record work queues, following the department's approved process.
• May assist department leadership with orientation and training.

Licensure, Registration, and/or Certification

None required.

Education

High School Diploma or GED required.

Experience

None required.

Knowledge, Skills & Abilities

• Demonstrates the Advocate Health purpose, values, and behaviors.
• Ability to work in a high-profile, high-stress area, working independently to set and meet deadlines, multitask, and prioritize work.
• Must be able to manage high-volume workloads with many interruptions in a fast-paced environment without direct supervision.
• May be cross-trained across various specialties and provide staffing support as needed.
• Strong attention to detail and accuracy.
• Excellent customer service skills in a variety of situations.
• Must have excellent service recovery skills.
• Demonstrated independent thinking and problem-solving skills; ability to exercise judgment to triage issues and concerns.
• Excellent communication (written and verbal), customer service, and interpersonal skills; ability to effectively communicate with a variety of patients, visitors, staff, and physicians in a pleasant, professional demeanor.
• Educates patients on the insurance coverage aspect of their care, including managing the discussion for services that will not or may not be paid by their health plan.
• Interacts with physicians and their staff to resolve issues related to patient care.
• Collects and manages payments, including cash payments if applicable, and follows security procedures related to cash handling.
• Strong understanding and comfort level with computer systems and proficient typing skills.