Patient Services Representative

Position Overview:
The Patient Services Representative is responsible for handling front office functions. This work is carried out in support of the mission and goals of Ryan Health.

Essential Functions:
Patient Processing:

• Check in patient's visit and create same day visits when necessary.
• Collect copays from insured patients and appropriate fees from uninsured patients, including any outstanding balances.
• Verify insurance coverage using appropriate equipment, and bill patient's insurance for services.
• Direct 3rd Party, private insured patients to Patient Accounts Department.
• Ensure that referrals and authorization for Specialty services are obtained before processing patient's visit.
• Screen patient for Sliding fee eligibility
• Inform eligible patients of assistance available for entitlements, including but not limited to Medicaid plans, Managed Care plans accepted at the Center, ADAP and refer them to appropriate staff.
• Balance patient revenue collected for bank deposit.
• Orient patients to services, procedures, and information regarding the William F. Ryan Community Health Center, including but not limited to hours, fees, scheduling and canceling appointments, patient rights, and Board of Directors.
• Collect and ensure all patient information is appropriately signed and scanned into the patients' hub.
• Assist the patient when necessary to change PCP by calling insurance plan.
• Use appropriate equipment to capture patient photo when authorized by the patient.

• Update/recertify patient registration information, as necessary, or when patient reports a change, including but not limited to income, insurance, address, telephone, number of dependents, etc.
• Refer patients to appropriate Ryan Health departments and community or social agencies as needed.
• Check-out patients after booking all appointments as per provider instructions.
• Ensure that telephone encounters are processed efficiently and appropriately.
• Book and/or Status referral requests appropriately including but not limited to Diagnostic and procedure orders.
• Schedule and status urgent/STAT/High Risk referrals as per procedure.
• Review practitioner schedules and mark no-show appointments.
• Verify patient address/telephone number for certified mail.
• Consult with provider and/or authorized staff when provider's schedule must be overridden.
• Pose as Greeter when assigned by Supervisor

Insurance Processing:

• Verify detailed insurance information for all services provided at the Center, including but not limited to Commercial, MLTC and supplemental plans.
• Screen and complete insurance applications for eligible patients
• Process payment plans/bills, when applicable, including but not limited to Itemized bills.
• Process Utilization Thresholds.
• Assist patients with insurance restrictions.
• Maintain and update the insurance verification via electronic medical Record (EMR) system
• Update and maintain information per current procedure.
• Attend trainings and webinars as assigned by Supervisor.

Referral Processing:

• Ensure the appropriate Specialty Referral Form, if required, has been initiated and that all required information is provided; including the number of visits and expiration date of the referral.
• Fax referral form and supporting documents (i.e. progress note, radiology reports, laboratory results) as attached by the practitioner, to Off-Site specialists via fax.
• Obtain prior authorization for specialty visits, when required by the patient's insurance carrier.
• Schedule appointments to the appropriate off-site specialist as per the practitioner's note, or patient's preference.
• Document the specialty appointment date, time and location in the patient's Electronic Health Record (EHR)
• Maintain assigned referrals in accordance with the Network's referral management policy and procedure.
• Process, monitor, and reconcile Urgent/STAT/High-Risk referrals.
• Ensure appointments for Urgent/STAT/High-Risk referrals are scheduled in accordance with the timeframe specified in the Network's referral processing and tracking policy and procedure.
• Monitor Urgent/STAT/High-Risk specialty appointments to verify patient attended the appointment.

• Obtain consultation reports from specialty providers in order to reconcile and address Urgent/STAT/High-Risk referrals.
• Review monthly report of all Urgent/STAT/High-Risk referrals to track metrics related to the timeliness in which referrals are processed and addressed.
• Responsible for maintaining and updating incoming referrals to ensure that all off-site appointments are scheduled.
• In the patient's EHR, document the status of off-site specialty appointments.
• Contact the patient with appointment information, via the patient's preferred method of contact.
• Print and mail completed referral form to patient.
• Call the patient with appointment information when the appointment date is within five business days or less.

Other:

• Review billing/global alerts before processing patients.
• Immediately report any problems or unusual occurrences to supervisor.
• Other duties and/or projects as assigned.

Minimum Experience and Skills Required:

• Experience in front office healthcare environment.
• Must enjoy working with the public and be able to respect patient confidentiality.
• Working knowledge of Electronic Health Record systems.
• Excellent communication and interpersonal skills.
• Strong customer service skills.

Education, Licenses and/or Certifications Required:

• High School Diploma or GED.

Preferred Qualifications:

• Experience with eClinicalWorks electronic health record system.
• Experience working in a community or human services agency.
• Bilingual English/Spanish.

Competencies Required:

Customer Service:

• Professional, courteous and respectful attitude in dealing with patients.
• Demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient served.
• Commits to exceeding expectations of the patient.

Cooperation/Teamwork

• Works well with others.
• Contributes input to improve outcomes.
• Asks others for opinions and feedback; provides feedback in a tactful respectful way.

Minimal Training Time:

90-day probationary period.

Working Conditions:

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit, stand, talk and hear.

The employee is occasionally required to move about the office; use hands and fingers to feel, handle, or operate office equipment.

Specific vision abilities required by this job include close vision and the ability to adjust focus.


Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.


Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The work is primarily in an ambulatory primary care setting which includes the unpredictability in behaviors of individuals and acute and chronic infectious diseases which may be contagious. Adequate preparation and precaution is necessary.

Disclaimer

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. This position may be required to perform other duties. If such work becomes a permanent and regular part of the job, a new description will be prepared.

Equal Opportunity Employer

Ryan Health is an Equal Opportunity Employer and does not discriminate on the basis of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, gender identity, military veteran status, or any other characteristic protected by law.