Patient Service Representative I

Major Responsibilities

• Creates the initial electronic health record that serves as the foundation of the patient medical record that is utilized by 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 positively identify a 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. Obtaining accurate information at the point of registration helps ensure timely payment to the organization and prevents billing issues and patient complaints. Maintains complete confidentiality regarding patient personal/financial information and medical records in accordance with the 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 of financial responsibility is needed. Understands and discusses financial information and obligations with patients. Knows how and when to refer patients to Financial Advocates.
• Has knowledge of which rules, forms and questions must be enforced to make sure Advocate Health remains compliant 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 or guarantor signatures as required.
• May schedule patient appointments: may also coordinate cancellations, reschedules, wait list requests, and recall requests. Provides accurate, detailed information regarding test 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 by demonstrating extraordinary customer service. Greets patients and visitors and responds to routine requests for information. Answers telephone, screens calls, and takes messages. Offers various assistance to patients to include arranging transportation needs, providing directions, locating a 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 Advocate Health purpose, values and behaviors.
• Ability to work in a high profile and high stress area, working independently to set and meet deadlines, multitask and 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. Must have 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, staff and physicians in a pleasant professional demeanor.
• Educate patients on the insurance coverage aspect of their care including managing the discussion for services that will not or may not be paid by their health plan.
• Interact with 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 technical proficiency including experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, electronic email, Microsoft Office, internet browser and phone technology.
• Understanding of basic 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 and comply with updates 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 be required based on service location.
• Notary training/licensure may be required as appropriate for service 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 standing frequently. 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. with assistance. Occurs when moving equipment, supplies and/or when transporting patients through doorways, ramps and elevators.
• Escorts patients to nursing units or outpatient departments as necessary.
• Sensory requirements include vision, hearing and touch. Must also be able to speak clearly.
• Must be able to use hands with fine motor skills for keyboard data entry.
• May be asked to work a flexible schedule at times to meet the needs of the department.

Preferred Job Requirements

Experience Required

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