Patient Service Representative I

Major Responsibilities:

• Creates theinitialelectronic health record that serves as the foundation of the patient medical record that isutilizedby all members of the healthcare team. Prevents creation of duplicate medical records that can cause treatment safety issues and billing problems. Follows and ensures compliance with the mandate of the organization’s accrediting bodies to use identifiers to positivelyidentifya patient prior to the delivery of patient care to ensure patient safety.
• Checks in and registers patients; obtains and verifies complete demographic, guarantor, and insurance information; discusses and collects co-pays and other out-of-pocket patient responsibilities. Obtainingaccurateinformation at the point of registration helps ensuretimelypayment to the organization and prevents billing issues and patient complaints. Maintains complete confidentialityregardingpatient personal/financial information and medical recordsin accordance withthe Health Insurance Portability and Accountability Act (HIPAA).
• Knows insurance basics and recognizes commercial and government plans. Understands which plans Advocate Health contracts with and when a statement offinancial responsibilityis needed. Understands and discusses financial information and obligations with patients.Knowshow and when to refer patients to Financial Advocates.
• Has knowledge of which rules, forms and questions must be enforced to make sure Advocate Healthremainscompliant with government agencies and regulations. Examples are HIPAA, Emergency Medical Treatment and Active Labor Act (EMTALA), Consent for Treatment, Patient Rights and Responsibilities, Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), Notice of Privacy Practices, Medicare Secondary Payer Questionnaire (MSPQ), Advanced Beneficiary Notice (ABN). Obtains patient orguarantorsignatures asrequired.
• May schedule patient appointments: may also coordinate cancellations, reschedules, wait list requests, and recall requests. Providesaccurate, detailed informationregardingtest preparations, patient arrival time, medication/food/beverage consumption guidelines, check-in procedures, directions to facility, etc.
• Creates a welcoming and professional environment for our patients and visitors bydemonstratingextraordinary customer service.Greetspatients and visitors andrespondsto routine requests for information. Answers telephone,screenscalls, and takes messages. Offers variousassistanceto patientsto includearranging transportation needs, providing directions,locatinga wheelchair, coordinating interpreter services, etc.
• Monitors and works assigned electronic health record work queues, following the department’s approved process.

Licensure, Registration, and/or Certification Required:

• None

Education Required:

• High School Graduate.

Experience Required:

• None

Knowledge, Skills & Abilities Required:

• Demonstrate the AdvocateHealthpurpose,valuesand behaviors.
• Ability to work in a high profile and high stress area, working independently to set and meet deadlines,multitaskand prioritize work. Must be able to handle large workloads with many interruptions in a fast-paced environment without direct supervision.
• Strong attention to detail and accuracy.
• Excellent customer service skills in a variety of situations.Musthave excellent service recovery skills.
• Demonstrated independent thinking and problem-solving skills, ability to exercise judgment to triage issues and concerns.
• Excellent communication (written & verbal), customer service and interpersonal skills, ability to effectively communicate with a variety of patients, visitors,staffand physicians in a pleasant professional demeanor.
• Educate patients on the insurance coverage aspect of their care including managing the discussion forservices that will not or may not bepaidby their health plan.
• Interactwith physicians and their staff to resolve issues related to patient care.
• Collect and manage payments including cash payments and follow security related to cash handling.
• Strong understanding and comfort level with computer systems. Demonstrated technicalproficiencyincluding experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, electronic email, Microsoft Office, internetbrowserand phone technology.
• Understanding ofbasic medical and insurance terms and abbreviations typically used in the patient scheduling and registration process.
• HIPAA-compliant and knowledgeable of applicable state and federal rules/regulations. Ability to handle sensitive and confidential information according to internal policies.
• General understanding of health insurance: Medicare, Medicaid, managed care, and commercial payers. Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations andcomply withupdates on insurance pre-certification requirements.
• Excellent organizational skills.
• Demonstrated ability to effectively act as a resource to other staff.

Physical Requirements and Working Conditions:

• This position may require travel, therefore, will be exposed to weather and road conditions.
• Responds quickly to patient medical status and emergency situations occurring in clerical areas.
• CPR certification may berequiredbased on service location.
• Notary training/licensure may berequiredasappropriate forservice line and/or facility.
• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment with significant patient and public contact. May be exposed to ill or contagious patients.
• Must be able to transition from sitting to standingfrequently. Must be able to stand and sit for extended periods of time and be physically mobile throughout the workday.
• Frequently lifts to 10 lbs. and occasionally lifts 20 lbs. or more. Must be able to push/pull up to 50 lbs. withassistance. Occurs when moving equipment, supplies and/or when transporting patients through doorways,rampsand elevators.
• Escorts patients to nursing units or outpatientdepartmentsas necessary.
• Sensory requirements include vision,hearingand touch.Must alsobe able to speak clearly.
• Must be able to use hands with fine motor skills for keyboard data entry.
• May be asked toworka flexible schedule at times to meet the needs of the department.

PreferredJobRequirements:

Experience Required:

• Preferred: experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, electronic email, Microsoft Office,Internetand phone technology.

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.