Patient Services Representative

Job Title

Enhances clinicians' effectiveness by providing information management support, which includes answering and triaging phone calls, scheduling patients visits, verifying and securing both initial and ongoing insurance coverage for therapy services, and providing patients with relevant information concerning their insurance coverage.

Essential Functions

Office Skills

• Demonstrates excellent interpersonal communication skills that translate across the phone, e-mail and in person.
• Effectively and efficiently schedules patients' initial and follow up visits as needed.
• Greets patients & visitors; Registers patients.
• Assists with answering & triaging referral telephone calls; demonstrates the ability to understand and differentiate between the different types of therapy.
• Utilizes patient EMR system
• Collects and verifies insurance information for new and existing patients who have a change in insurance during course of care.
• Attains correct insurance benefit information from insurers.
• Communicates benefits, and potential financial responsibility to patients.
• Collects patient copays at time of service and consolidates payments on a weekly/daily basis based on location.
• Follows up with patients who have out-of-pocket costs.
• Communicates with and resolves patient questions regarding insurance and benefits.

Obtains Authorization for Necessary Services from Insurers for Patient

• Performs accurate and timely maintenance of authorization functions, referrals and visit limit tracking in Cerner.
• Prevents disruption of service by securing necessary authorizations prior to the end date after consulting with therapist.
• Answers patient calls regarding authorization questions.
• Researches denials due to authorization or referral issues to determine cause and resolution; resubmits claims after gathering necessary information.

Assists in Obtaining Patient Satisfaction Surveys

Performs Other Duties as Requested

Documentation

• Accurately utilizes patient EMR system
• Accurately copies record when requested
• Accurately tracks the need for insurance reauthorizations for patients

Team Effort

• Identifies work unit issues & implements solutions
• Orients new staff
• Demonstrates flexibility to help others (provide coverage, adjust work schedule to meet needs)
• Shares knowledge with others
• Embraces change and promotes a positive work environment
• Demonstrates management skills by prioritizing, organizing and completing job responsibilities.

Protects Customer and Organization Information

• By keeping information confidential, following Good Shepherd's policy and procedures for release of information, maintaining secure medical records and maintaining security for the contents of the business office.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

• High School Diploma required
• Associate's Degree preferred

Work Experience

• 1-2 years of experience in an administrative position with computer skills required
• Prior health insurance experience preferred

Licenses / Certifications

• Basic Life Support / CPR, as a healthcare provider, per the American Heart Association preferred