Patient Service Rep III

Patient Service Rep III - 89331 Northern Light Eastern Maine Medical Center Department: Physician Practice Central Ops Position is located: Cianchette Professional Building Work Type: Full Time Hours Per Week: 40.00 Work Schedule: 8:30 AM to 5:00 PM Summary: The Patient Service Representative III is a supporting position and is responsible for a variety of activities related to patient in-take and care. The Patient Service Representative III will also support the Patient Service Representatives I and II as required and may be the first point of contact for patients entering the practice. It involves all of the responsibilities of the PSR II but with a higher level of competency and experience. Activities may include but are not limited to greeting and checking in patients, verifying and updating insurance information and confirming other patient information, scheduling patient appointments, answering phones, updating demographic information, processing referrals, payment collection and posting, charge entry, chart preparation, processing of payroll, tracking of time and attendance, tracking of quality metrics, daily charges, schedule management, patient panels, taking meeting notes, assist with patient complaints ordering office supplies, assisting with practice orientation and training of new staff and other duties as assigned with a minimum of support. The PSR III will also be able to coordinate all components of patient appointments to include tests, surgeries and procedures and may work closely with Central Scheduling. The PSR III will be expected to work with a fair amount of independence applying logic and judgement towards the resolution of practice challenges. The PSR III will serve as a role model of service and professionalism to all supporting staff. This role will provide help with mentoring new staff. Responsibilities: Demonstrates effective and courteous Customer, Physician/Practice Staff and other hospital staff communication skills. Communicates in a way that conveys understanding and respect to a diverse patient and work population. Answers all calls promptly and courteously. Responds to and resolves issues promptly through effective communication. Uses appropriate chain of command. Feedback is provided in a constructive manner. Demonstrates problem solving skills by responding to and resolving issues promptly through effective communication skills. Maintains adaptability in work schedule to meet patient/departmental needs. Develops and maintains positive working relationships. Acts as a resource to coworkers. Confirms patient identity by using the full name. Participates in problem solving groups as requested. Gives instructions and directions in a clear, understandable manner. Handles patient/family situations that have been escalated to the PSR II in a calm, courteous and informed professional demeanor. Attends all practice staff meetings. Greeting patients, having patient(s) sign appropriate forms/consents. Verifying and updating demographic/insurance information on all encounter forms and systems per protocol. Notifying registration of changes if applicable. Demonstrating mastery of appropriate practice software and registration tool protocols. Scheduling tests, procedures, referral appointments with scheduling center, agencies and/or other provider groups and forwarding order form and/or records to appropriate. depart/office. Documenting information in Patient's chart. Processing insurance referral/prior authorization and document this per protocol. Retrieving and processing messages per protocol. May assist with orientating and training/cross-training of new and established employees as assigned. Has the knowledge and the ability to train support staff at all practice levels and for all practice functions, if appropriate. May provide coverage in other areas. Effectively covers other support positions (e.g. switchboard, insurance referrals, and scheduler), if appropriate. Provides excellent customer service for both internal and external customers. Responds to communications (phone calls, voice mails, e-mails and IMs) in a timely manner. Demonstrates mastery of and acts as a resource for all systems used in the front office, including scheduling and registration protocols, if appropriate. Takes ownership for determining customers' needs and offering assistance. Interacts with other Northern Light Health functions with confidence, courtesy and professionalism. Assists the practice manager in organizing, coordinating and implementing projects. Collects and compiles statistical data to assist the practice manager as required. Schedules outpatient testing per orders/referral process, inputs appointment dates and times into patient EMR, if appropriate. Recognizes problems and offers constructive solutions. Is able to implement solutions with direction from the practice manager. Is able to run staff meetings in the practice manager's absence. Acts as a designee for the safety officer for practice, to include all safety training, conducting safety related drills, documenting all safety procedures. The PSR III will also participate in disaster drills, demonstrate understanding of disaster plan in discussion drills and disaster situations. The PSR III will also perform duties as assigned to meet unusual, emergent and practice needs. 100% documented evidence of attendance of department staff meetings and/or reading/initializing the minutes. Performs other duties as assigned by practice leadership. Consistent and reliable attendance including communication and attempts to find coverage when issues prevent attendance. Reviews material submitted by Health Plans and Managed Care Organizations to gain full understanding of benefit coverage and precertification/authorization, if appropriate. Quality review procedures are followed to ensure accounts are brought to a timely and accurate resolution, if appropriate. Adheres to Organization Code of Conduct and follows all applicable compliance policies and regulations. Ability to prioritize and perform multiple duties, simultaneously. Ability to take ownership of work and follow up on responsibilities. Speaks, spells, and writes clearly, concisely and to the point. Consistently follows Patient Identification IDD by using two patient identifiers related to the registration process. Patient Identification Manager will be alerted if duplication medical record numbers are identified. Proper name format is consistently followed. Managed care organizations are correctly identified and selected as part of the registration process, if appropriate. Timely modifications of registrations are done in order to ensure billing of encounters. Uses independent judgment, when necessary, if appropriate. Assists Practice Manager with patient complaints related to billing invoices, if appropriate. Appropriately refers patients/staff with issues/concerns to the Practice Manager. Performs Service Recovery when necessary. Seeks ways to improve quality of services provided. Has 100% of iCare, employee updates and any other in-services meetings and training as assigned. Maintains documented evidence of continuing education. Participates in multidisciplinary problem-solving groups, in-service and departmental, practice and hospital meetings as requested; may participate as PM's proxy. Works safely and follows all safety policies, reports incidents or hazards immediately. Follows all hand hygiene protocols. Strong knowledge of departmental policies, procedures and workflows. Insurance verification and precertification is performed prior to elective inpatient admission to ensure accounts are secured upon admission, if appropriate. Monitors overtime of staff and alerts supervisor, manager and employee of any overtime listed, if appropriate. For all other non-scheduled inpatients, insurance verification and precertification is performed within 24 hours of admission or by the end of the business day to perform due diligence on accounts that admitted the previous day, if appropriate. Names, dates, and times of conversations with businesses, insurances, managed care organizations, Utilization Review, and patients are documented, if appropriate. Insurance verification and precertification is performed on high dollar outpatient areas to ensure reimbursement, if appropriate. Understands the implication both clinically and financially of registration errors and the impact on the organization. Referral calls are made to PCP for Managed Care patients, if appropriate. Correct insurance is identified and selected when appropriate within the registration fields, if appropriate. Policy numbers are entered correctly into the registration fields, if appropriate. Ensures that referral authorization numbers are submitted to Patient Account Services in a timely manner and understands the implications if this is not done, if appropriate. Finishes work on time 95% of the time, avoiding overtime.