Patient Services Representative ll

Brief Description JOB ESSENTIAL DUTIES: Patient Access & Front Office Operations Provides friendly, courteous, professional, and informative service to all patients, visitors, and staff. Answers incoming telephone calls promptly and accurately directs or assists callers. Schedules appointments and enters demographic and insurance information accurately into the electronic medical record. Verifies patient identity utilizing established MCR Health procedures. Obtains, verifies, and updates patient demographic information and insurance coverage. Conducts pre-visit verification and appointment confirmations. Assist patients with registration forms and required documentation. Maintains confidentiality of Protected Health Information (PHI) and comply with all privacy and security standards. Performs health information management functions, including release of information activities and scanning documentation into the electronic medical record. Financial Counseling & Patient Assistance Evaluates patient eligibility for reduced fee programs and financial assistance programs.Assist patients with Healthcare Marketplace, Medicare, Medicaid, KidCare, and other health coverage applications.Provides enrollment support by gathering documentation, completing applications, and resolving enrollment issues.Educates patients regarding available healthcare coverage options and renewal requirements.Assist patients with enrollment recertification and renewal processes.Coordinates with billing and revenue cycle departments regarding patient account balances.Communicates financial obligations, including deductibles, co-payments, coinsurance responsibilities, prior balances, and payment expectations.Prepares Good Faith Estimates as required.Educates patients on payment plan options and available financial resources.Establishes payment plans and prepayment arrangements for qualifying patients.Verifies Medicaid eligibility and communicates findings to the billing department when applicable.Assist patients in accessing community resources and support programs. Insurance Verification & Authorization Support Performs insurance verification and eligibility review for scheduled patients.Reviews payer requirements and assists with securing necessary authorizations and referrals.Verifies benefits and communicates coverage information to patients.Assists patients in resolving insurance-related issues and coverage concerns.Serves as a liaison between patients, insurance carriers, billing, and clinical departments.Participate in training programs, webinars, and continuing education opportunities related to eligibility, enrollment, and patient services. SKILLS, KNOWLEDGE & ABILITIES: Excellent customer service and interpersonal skills. Strong verbal and written communication abilities. Knowledge of healthcare insurance programs, including Medicare, Medicaid, Healthcare Marketplace, and commercial plans. Strong problem-solving and critical-thinking skills. Ability to explain financial and insurance concepts to patients in an understandable manner. Exceptional attention to detail and accuracy. Ability to multitask and prioritize responsibilities in a fast-paced environment. Strong organizational and time-management skills. Proficiency with Microsoft Office products. Ability to maintain professionalism and confidentiality. Demonstrates compassion, empathy, and commitment to patient-centered service REQUIREMENTS & PREFERENCES: Associate’s degree in healthcare administration, business administration, or related field preferred.High School Diploma or GED equivalent.Minimum one (1) year of healthcare customer service, patient registration, financial counseling, eligibility, insurance verification, or related experience.Basic to intermediate proficiency with Microsoft Office applications.Knowledge of patient financial responsibility and insurance verification processes.Experience with Healthcare Marketplace, Medicare, Medicaid, and financial assistance program enrollment.Ability to periodically work extended hour (EH) shifts. Knowledge of Federally Qualified Health Center (FQHC) operations.Bilingual (English/Spanish) preferred but not required. PHYSICAL DEMANDS & EQUIPMENT USE: Physical demands described here represent those that must be met by an employee to successfully perform the job's essential functions. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions While performing the duties of this job, the employee is regularly required to drive, sit, use hands or fingers, handle or feel objects, tools, controls, and talk or hear The employee frequently is required to walk, stand, and reach with hands and arms The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl The employee must occasionally lift and/or move up to 25 lbs. Must be able to maintain a professional manner, tactful when voicing an opinion (constructive criticism) when necessary, in a manner that would not demean the profession, clinic, and self Must have the ability to communicate and establish effective working relationships Must be able to coordinate several activities to quickly analyze and resolve problems Understands that work can be stressful, and long hours are often required This job is not limited to the activities described above and this job description may be amended by management as deemed necessary Requirements REQUIREMENTS & PREFERENCES: Associate’s degree in healthcare administration, business administration, or related field preferred.High School Diploma or GED equivalent.Minimum one (1) year of healthcare customer service, patient registration, financial counseling, eligibility, insurance verification, or related experience.Basic to intermediate proficiency with Microsoft Office applications.Knowledge of patient financial responsibility and insurance verification processes.Experience with Healthcare Marketplace, Medicare, Medicaid, and financial assistance program enrollment.Ability to periodically work extended hour (EH) shifts. Knowledge of Federally Qualified Health Center (FQHC) operations.Bilingual (English/Spanish) preferred but not required. Summary POSITION SUMMARY: The PSR II provides a caring and compassionate environment for patients while promoting MCR Health's commitment to providing an Exceptional Experience to Everyone, Every Time. This position requires extensive knowledge of patient registration, insurance verification, financial assistance programs, Healthcare Marketplace, Medicare, Medicaid, and payment plan administration. The PSR II works collaboratively with clinical, billing, outreach, and revenue cycle teams to ensure patients have access to appropriate care and financial resources. The role combines the functions of a Patient Services Representative and Financial Counselor to ensure patients receive comprehensive assistance with scheduling, registration, insurance verification, financial assistance programs, payment arrangements, and healthcare coverage enrollment. PHYSICAL DEMANDS & EQUIPMENT USE: Physical demands described here represent those that must be met by an employee to successfully perform the job's essential functions. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions While performing the duties of this job, the employee is regularly required to drive, sit, use hands or fingers, handle or feel objects, tools, controls, and talk or hear The employee frequently is required to walk, stand, and reach with hands and arms The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl The employee must occasionally lift and/or move up to 25 lbs. Must be able to maintain a professional manner, tactful when voicing an opinion (constructive criticism) when necessary, in a manner that would not demean the profession, clinic, and self Must have the ability to communicate and establish effective working relationships Must be able to coordinate several activities to quickly analyze and resolve problems Understands that work can be stressful, and long hours are often required This job is not limited to the activities described above and this job description may be amended by management as deemed necessary