Patient Services Representative, Ambulatory Internal Resource Pool, FT, Days

Inspire health. Serve with compassion. Be the difference.

Job Summary

This is an entry level position in which incumbents are responsible for aspects of Physician Practice front office management and operation as assigned. May be responsible for some or all front office functions as detailed in the next section.

The Ambulatory Internal Resource Pool consists of full-time, part-time and PRN team members that work short term assignments at any of our medical offices in Greenville and the surrounding areas. The assignments can be as short as 1 day and as long as 12 weeks. Our team members need to be flexible and willing to work within all specialties including family medicine, pediatrics, urology, orthopedics, OB/GYN, etc. This position does offer a float differential on top of the experience based hourly pay rate.

Accountabilities

• Responsible for complete and accurate patient registration, precertification, charge capture and accurately coding

diagnoses given by physicians. Responsible for posting all payments and balancing with the computer reports at

day end. Requires a high level of public contact and excellent interpersonal skills. Arranges for patient

pre-payments and enforces financial agreements prior to providing service. Gathers charge information, codes,

enters into database, completes billing process, distributes billing information. Files insurance claims and assists

patients in completing insurance forms. Processes unpaid accounts by contacting patients and third party

payers. 20%

PATIENT ACCOUNTING/REGISTRATION/SCHEDULING

• Serves as a liaison between patient and medical support staff.
• Greets patients and visitors in a prompt, courteous, and helpful manner.
• Checks in patients, verifies and updates necessary insurance information in the patient accounting system (on line

Registration).

• Obtains signatures on all forms and documents as required.
• Assists patients with ambulatory difficulties.
• Maintains appointment book and follows office scheduling policies.
• Provides front office phone support as needed and outlined through cross training program.
• Responsible for gathering, accurately coding and posting outpatient charges to superbills.
• Processes vouchers and private payments, to include updating registration screens based on information on checks.
• Helps to process mail return statements and outgoing statements.
• Performs cashiering functions including monitoring and balancing cash drawer daily. Prepares daily cash

deposits. Receives payments from patients and issues receipts. Codes and posts payments and maintains required

records, reports and files.

• Processes edits and Customer Service and Collection Request for resolution within specified time frames.
• Maintains and updates current information on physician’s schedules.
• Schedules surgeries, ancillary services and follow-up outpatient appointments and admissions as requested.
• Oversees waiting area, coordinates patient movement, reports problems or irregularities. 20%

BILLING/FEE TICKET PREPARATION/MEDICAL RECORDS MAINTENANCE

• Researches all information needed to complete outpatient billing process including getting charge information from

physicians.

• Codes information about procedures performed and diagnosis on charge.
• Keys charge information into on-line entry program.
• Processes and distributes copies of billings according to clinic policies.
• Delivers, transports, sorts and files returned charts.
• Picks up lab reports, dictations, X-rays, and correspondence.
• Files all medical reports. Purges obsolete records and files in storage.
• Destroys outdated records following established procedures for retention and destruction.
• Makes up new patient charts. Repairs damaged charts. Assists in locating and filing records.
• Works with medical assistants and other staff to route patient charts to proper location. 20%

INSURANCE/PRECERTIFICATION/PREAUTHORIZATION

• Assist patients with questions on insurance claims, obtaining disability insurance benefits, home health care,

medical equipment, surgical care, etc.

• Processes benefit correspondence, signature, and insurance forms to expedite payment of outstanding claims.
• Assists patients in completing all necessary forms to obtain hospitalization or Surgical pre-certification from

insurance companies.

• Follows-up with insurance companies ensuring that coverage is approved.
• Posts all actions and maintains permanent record of patient accounts.
• Answers patient questions and inquiries regarding their accounts.
• Confirms all workers’ compensation claims with employees.
• Prepares disability claims in a timely manner.
• Maintains files with referral slips, medical authorizations, and insurance slips. 20%

COLLECTIONS AND OTHER FRONT OFFICE PRACTICE FUNCTIONS

• Collects payments at time of service for daily outpatient visit services.
• Performs collection actions including contacting patients by telephone and resubmitting claims to third party

reimburses.

• Evaluates patient financial status and establishes budget payment plans.
• Reviews accounts for possible assignment to collection agency, makes recommendation to Clinical Dept. Practice

Manager.

• Participates with other staff to follow up on accounts until zero balance, or turned over for collection. 10%

DATA ENTRY OPERATOR

• Enters all charge and same day payment information for patient visits and hospital patients, verifying accuracy of

coding, charging and patient insurance status.

• Backs up and closes computer files on a daily basis, logging as appropriate (i.e. closing all batches in accordance to

policy).

• Registers new patients after verifying patient status on computer inquiry. Updates financial information as indicated.

5%

MISCELLANEOUS

• Maintains strictest confidentiality.
• Participates in educational activities.
• As representative of GHS Clinical Department, is expected to maintain neat and professional appearance,

demonstrate commitment to serve at all times and uphold guidelines set forth in office manual. 5%

Supervisory/Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Education

High School diploma or equivalent

Minimum Experience

No previous experience required

Other Required Experience

Associate Degree in technical specialty program of 18 months minimum in length- Preferred

Multi-specialty group practice setting experience- Preferred

Basic understanding of ICD-9 and CPT coding- Preferred

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

Administration-Medical Group

Department

Ambulatory Internal Resource Pool

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.