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Patient Service Representative
Major Responsibilities:
Licensure, Registration, and/or Certification Required:
Education Required:
Experience Required:
Knowledge, Skills & Abilities Required:
Physical Requirements and Working Conditions:
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
- Greets and checks in patients arriving for their appointments. Ensures patient information is complete and accurate. Collects patient responsibility as identified in the pre-registration process.
- Completes the registration process on walk-in patients, verifies and/or updates patient demographic and insurance information if changes or additions have occurred.
- Verifies insurance benefits, obtains/calculates patient responsibility and request payment. Communicates to patient the organization expectation of payment at time of service.
- Identifies patients in need of financial assistance and refers patients to Financial Advocate when necessary. Collaborates with Financial Advocate to coordinate patient’s financial resources and responsibilities including requesting patient to sign a Financial Obligation Form (FOF) or Advanced Beneficiary Notice (ABN) as needed.
- Monitors patient flow to ensure patients are cared for in the most efficient and courteous manner. Performs visit closure, including checking out patients, collecting additional patient responsibility (when applicable) and providing patient with appropriate documents.
- Schedules patient visits using guidelines established within scheduling system.
- Assists with new caregiver onboarding.
- Works assigned EPIC work queues, following the department’s work flow process.
- Maintains excellent public relations with patients, families, and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information. Proactively communicates issues involving customer service and process improvement opportunities to management.
- Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.
Licensure, Registration, and/or Certification Required:
- None Required.
Education Required:
- High School Graduate.
Experience Required:
- Typically requires 1 year of experience in customer service or clerical/office experience, including answering phones and assisting customers.
Knowledge, Skills & Abilities Required:
- Demonstrated ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available.
- Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
- Mathematical aptitude, effective communication skills and critical thinking skills.
- Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre-certification/authorization processes.
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.
- Ability to speak effectively to customers or employees of organization, maintaining a pleasant, professional demeanor.
- Ability to handle sensitive and confidential information according to internal policies.
- Ability to problem solve in a high profile and high stress area, working independently to set and meet deadlines and prioritize work.
- Demonstrated technical proficiency including experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer and phone technology.
Physical Requirements and Working Conditions:
- Must be able to sit, stand, walk, lift, carry, squat, and bend frequently as well as twist, rotate, and kneel occasionally throughout the workday.
- Frequently lifts up to 10 lbs. and occasionally lifts between 20 lbs. or more. This occurs when moving equipment and supplies and when transporting patients and/or charts.
- Must be able to push/pull up to 50 lbs. with assistance.
- Must have functional speech and hearing.
- Must be able to use hands with fine motor skills for keyboard data entry.
- Exposed to a normal office environment.
- Operates all equipment necessary to perform the job.
- Must be able to work a flexible schedule to support the needs of the department.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
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