Patient Service Representative - Pulmonary

Representative Functions

• Performs complete and accurate registration and/or admission functions across multiple access services areas or sites to provide information to maximize reimbursement, and ensures timely and thorough information to all other providers and users of patient data.
  • Verifies insurance requirements, obtains and understands insurance benefits.
  • Collections non-covered fees.
  • Registers and pre-registers outpatients in more than one clinical and diagnostic location within their primary area of responsibility and multiple access areas outside hiring location.
  • Screens physician’s orders and pre-registration data for changes and compliance with payer requirements for medical necessity and pre-certification.
  • Reviews and completes changes to third party eligibility and benefits verification.
  • Enters and/or updates all required data in multiple hospital computer systems to activate accounts and notify clinical department of patient arrival.
• Interacts with patients and their representatives to collect and interpret all required demographic, insurance, financial, and clinical data necessary to facilitate patient check in and registration at point of service.
  • Offers and/or schedules interpreter services for patients when necessary.
  • Obtains and scans general consent for treatment, identification and insurance cards, Coordination of Benefits and other appropriate documents.
  • Obtain and submit National Provider Identification (NPI) for providers not on staff ordering outpatient diagnostic tests.
  • Interpret physician orders for completeness and compliance with regulatory agencies and NCH policies.
  • Informs patients of registration processes and privacy notification, establishes financial responsibility to meet internal, regulatory or payer requirements.
  • Completes the Medicare Secondary Payer (MSP) questionnaire and discusses potential deferral of services according to NCH policy.
  • Initiates the Medicare Advance Beneficiary Notice (ABN), as appropriate, and explains payer policies to patients.
  • Streamlines check in process for patient previously pre registered and appropriately updates the account for changes identified upon arrival.
  • Reviews physician’s orders for compliance with the Illinois Department of Public Health (IDPH), and the Center for Medicare & Medicaid Services (CMS) regulations and NCH and medical staff office policies.
  • Maintains current knowledge of insurance requirements communicated by email, memorandum, educational matrices and in-services.
  • Provides support to primary care practices and specialty care providers regarding utilization, authorization and referral activities.
  • Communicates effectively with service delivery areas when unresolved financial issues impact appointment schedules.
• Minimizes third party payer denials by verifying authorization of service prior to forwarding patients to service delivery areas.
  • Maintains current knowledge of insurance requirements communicated by email, memorandum, educational matrices and in-services.
  • Provides support to primary care practices and specialty care providers regarding utilization, authorization and referral activities.
  • Communicates effectively with service delivery areas when unresolved financial issues impact appointment schedules.
• Collaborate with internal and external customers to provide timely resolution to third party payer requirements prior to date of service.
  • Collaborate with internal and external customers to provide timely resolution to third party payer requirements prior to date of service.
• Identify clinical and financial criteria that require involvement of Case Management team or Financial Counseling.
  • Identify clinical and financial criteria that require involvement of Case Management team or Financial Counseling.
• Resolves all work queues within Department standards determined time period to release bill holds to ensure timely reimbursement.
  • Resolves all work queues within Department standards determined time period to release bill holds to ensure timely reimbursement.
• Log cash collected receipts and maintain balanced cash at all times.
  • Log cash collected receipts and maintain balanced cash at all times.
• Coordinates scheduling of service areas for patients requiring multiple tests.
  • Coordinates scheduling of service areas for patients requiring multiple tests.
• Identify and assign electronic educational programs for scheduled services.
  • Identify and assign electronic educational programs for scheduled services.
• Explains patient prep and way finding instructions to patient.
  • Explains patient prep and way finding instructions to patient.
• Aids in the preparation of patients for testing and procedures.
  • Aids in the preparation of patients for testing and procedures.
• Assists with other tasks to support the clinical department as determined by the Manager of Patient Access.
  • Assists with other tasks to support the clinical department as determined by the Manager of Patient Access.

Special Skills And Abilities Required

• Ability to functionally navigate multiple computer software systems with accurate keyboard skills following computer security protocols.
• The interpersonal communication skills necessary to interview and interact with customers and physicians and to project a professional and compassionate concierge style of service to patients, patient families, physician’s and staff in person and on the telephone.
• Ability to work independently, exercising good judgment, and multi-task in a high stress, fast paced service environment with patients, patient’s family and physician’s.
• Detail oriented with good analytical problem-solving skills to appropriately register patients and schedule patient procedures.
• Ability to operate routine office equipment (facsimile, copiers, plate production, scanners, printers).
• Ability to transact payments at time of service and maintain a cash drawer.

Knowledge, Practical Experience And Licensure/Registration Required

• High school diploma required.
• College degree preferred.
• Minimum 2 Years Of Customer Service Work Experience Required.
• Minimum of 1 year experience in a healthcare patient access department or hospital required.
• Computer Experience In a Windows Environment Required.
• Previous healthcare experience with regulatory compliance requirements, payer requirements, HIPAA privacy and security requirements, and general revenue cycle procedures required.
• Successful on-the-job completion of NCH Patient Access Specialist I competencies required.
• Epic Registration And/or Scheduling Experience Preferred.