Pt Serv Rep (MHO)

About the role

Reports to the Manager or Director. Is responsible for the coordination of services for patients at the assigned clinic or site, which includes registration, admitting and discharging patients, scheduling of all new and existing patients, coordinating patients with providers' schedules, contacting payors for authorization/documentation/pre-certification, researching/gathering required outside patient records, and scheduling all ordered imaging and procedural appointments.

Responsibilities

• Schedules new patients upon physician referral and gathers outside records and imaging as needed with special attention to coordination of care according to disease site.
• Greeting patients upon arrival and accurately completing check in/registration process.
• Admitting and discharging patients, which includes discharging from computer system, completing chart audit form, discharging the patient chart.
• Communicating, verbally, electronically, or in writing with payors to ensure appropriate verification of services and payment.
• Completes check out process with patient after appointment which includes scheduling next appointment and/or scheduling coordinated imaging/procedures.
• Copies patient records and billing when appropriate for insurance companies, attorneys, subpoenas, patients, Vocational Rehabilitation and Disability Determination Board.
• Performing a variety of secretarial duties (i.e., typing, computer, greeting customers, answering the telephone, filing, etc.).
• Coordinating patient visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential.
• Answering high volume of incoming phone calls as well as making high volume of outbound phone calls, with constant communication to the dept clinical team, referring provider offices and Centralized Scheduling department.
• Properly triaging and/or handing incoming patient concerns / phone calls; making sure critical issues are addressed in a timely manner.
• Registers Patients (to Obtain Demographic, Physician And Insurance Information In Accordance With Established Departmental Policies And Procedures) And Collects Applicable Co-payments And Deductibles By Interviewing patients via telephone for pre-admission or upon presentation for admission in the registration area.
• Obtaining identification, demographic, physician, and insurance information from patients and accurately entering this information into the Hospital financial system.
• Updates system after validation of the new patient's financial information.
• Explaining about the possible need to pre-certify with the patient's insurance carrier to ensure maximum coverage to the limits of the insured's insurance policy.
• Create patient estimate and requests payment either during the pre-registration process or when the patient presents for service in accordance with policies and procedures.
• Verifying and documenting insurance coverage via online eligibility systems, internet resources or via telephone.
• Requesting copies of the insurance card(s) and driver's license or other government picture ID to confirm insurance benefits and identification.
• Validates medical necessity via the MCA Compliance Checker where applicable.
• Completing the MSP (Medicare Secondary Payor) questionnaire by asking the patient the questions based on pt availability.
• Requesting payment either during the pre-registration process, when the patient presents for service or at Patient Check Out in accordance with Beacon's policies and procedures.
• Referring the patient to the Financial Counselors or Eligibility Specialists if they are unable to secure satisfactory payment arrangements and have a self-pay balance of $500 or more. Also assisting in obtaining additional patient information, copies of insurance card(s) and church information.
• Obtaining all required signatures for the "consent to treat" and assignment of insurance benefits forms.
• Obtaining pre-certification information from the insurance company's pre-certification unit (i.e., whether pre-certification is required, if the ordering physician has completed it, etc.).
• When the ordering physician has not completed the pre-certification, calling the physician's office to initiate the pre-certification process, and following up until it has been completed.
• When the ordering physician has completed the pre-certification, documenting the authorization, and releasing the account.
• Assists the department to meet or exceed its quality assurance goals.
• Maintains records, reports and files as required by departmental policies and procedures.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.
• Supports the Director and Manager in the completion of special reports and/or department documentation and utilizing the Hospital computer system to run routine client service and demographic reports.

Organizational Responsibilities

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies, and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Patient care providers are required to maintain current BCLS (CPR), and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Education And Experience

The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent); additional college-level business courses are preferred. Two to three years of progressively responsible experience in a related healthcare services environment is required.

Requires a thorough knowledge of general office policies and procedures, secretarial functions, and outpatient clinical services.