Patient Services Representative

Patient Service Specialist Patient Relations

The Patient Service Specialist Patient Relations (PR) ensures the Mission/Vision and financial integrity of Health First, Inc. by achieving sustainable levels of internal and external customer service, regulatory compliance, and financial performance within the revenue cycle.

Primary Responsibilities:

• Prepare charts for scheduled patients, obtain and verify authorizations, perform medical necessity, and ensure accurate orders are in place for all service lines.
• Register patients by using two patient identifiers (name, date of birth, etc.), confirm armband accuracy, input demographics information, and secure the required forms to meet compliance with regulatory policies.
• Perform Medicare compliance review on all applicable Medicare accounts in order to determine coverage. Identify patients who may need Medicare Advance Beneficiary Notices of Noncoverage (ABNs). Issues ABN forms as needed.
• Complete Medicare Secondary Payer Questionnaire (MSPQ) for Medicare beneficiaries.
• Verify insurance eligibility and benefits through eligibility systems or contacts insurance companies by phone, fax, online portal, and other resources to determine extent of coverage within established timeframe before scheduled appointments and during or after care for unscheduled or emergent patients.
• Calculate patients co-pays, deductibles, and co-insurance. Provide patients with personalized estimates of their financial responsibility based on their insurance coverage prior to service for both emergency and outpatient services.
• Attempt to collect patient cost-sharing amounts (e.g., co-pays, deductibles) and outstanding balances prior to service and post payments.
• Ensure compliance with state and federal laws regarding all aspects of role.
• Proficient and able to function in all Registration environments. Mentor staff and assist with training new staff on department specific procedures and applications.
• Daily reconciliation of payment collections, preparation of bank deposits, and petty cash distribution.

Work Experience:

Minimum Qualifications:

• Education: High School Diploma or equivalent.
• Work Experience: One (1) year of Customer Service experience.
• Licensure: None
• Certification: American Heart Association (AHA) HeartSaver CPR AED course prior to start date and maintained.

Skills/Knowledge/Abilities:

• Excellent communication/interpersonal skills and professional presence.
• Working knowledge of Microsoft Office-Outlook, Word, Excel.
• Ability to work autonomously with minimal supervision.
• Ability to apply logic and common sense to identify issues related to work performed.
• Foundational critical thinking skills.
• Ability to maintain composure in stressful work environment.
• Ability to prioritize and organize to maximize quality, value, and service.
• Ability to adapt to a potentially rapid changing environment or work process.
• Excellent teamwork and collaboration skills.

Preferred Qualifications:

• Work Experience: Two (2) years office or Customer Service experience.
• Skills/Knowledge/Abilities: General knowledge of healthcare terminology. Experience working in multiple computer systems simultaneously. Strong organizational skills.

Physical Requirements:

• Physically agile; may require walking, standing, running, bending, stooping, kneeling, climbing, or crouching frequently.
• May occasionally include lifting or moving objects up to 50 pounds, with or without assistance.
• May require moving in different positions to accomplish tasks in various environments including tight and confined spaces, including reaching out and above shoulders, or overhead.
• May lift, turn, pull, push, or ambulate people and/or equipment with or without assistance up to 90% of the assigned shift.
• May be exposed to inside and outside environments with varied temperatures, air quality, lighting, and/or low to loud noise.
• May require working with biohazards such as blood/body fluids and airborne particles following OSHA and CDC guidelines.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined.
• May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

About Health First:

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.