Patient Services Representative

Job Description

Position: Patient Services Representative


Effective Date : October 2009


Department: Patient Services


Revision Date : April 2019


Supervisor: Practice Manager


Exemption Status : Non-exempt

I POSITION SUMMARY:

Greets patients and ensures a complete and accurate check-in and check-out process for patients. Obtains all data elements necessary to process patients claim for insurance benefits and for accurately billing patient for any co-payments, deductibles and non-covered services.

II ESSENTIAL DUTIES AND RESPONSIBILITIES :

• Acknowledges patient upon their arrival and greets them in a friendly, professional manner.
• Obtains or updates patients demographic information and copies insurance cards at every visit.
• Correctly enters all required data elements into the physician practice management system.
• Answers patient and family member questions as needed and appropriate.
• Follows appropriate workflow processes for check in and check out. Pulls routine eye plans and obtains authorizations (VSP, EyeMed, Community Eye Care ).
• Verifies and reviews eligibility in NextGen and all payer sites as necessary. Files Charges in NextGen and routine vision system (VSP).
• Accurately calculates patient charges and collects required co-payments for services rendered.
• Monitors missing charges in NextGen and work with clinical teams to get charges entered in a timely fashion.
• Prepares charts by performing pre-registration review; Prepare any charts where physician may travel to occasional location (ie. Washam); Prepare premature baby charts.
• Floats between Check-In and Check-Out in order to ensure that coverage corresponds to patient volume.
• Provides support to technical staff and physicians as required to ensure timely flow of patients through the system.
• If assigned bilingual responsibilities, monitors all Spanish NotifyMD web messages. Handles all Spanish calls and voicemails. Reviews and approves translated correspondence and patient forms. Serves as translator for Surgery Coordinators when needed.
• Scans correspondence received in mail or fax to Cotswold.
• Schedules patient appointments including triage patients. Schedules web appointments that have been requested by patients.
• Uses multiple practice management systems to extract information
• Complies with petty cash policy daily.
• Prints physician schedules for clinical teams.
• Faxes referrals received to the referral department. Distributes faxes.
• Answers telephone in a timely manner in a customer friendly manner

IV. POSITION REQUIREMENTS:

Minimal Qualifications: consider if each item is truly required

1. High school diploma or equivalent.
2. Two (2) years of customer service experience, preferably in a medical/ophthalmic environment.
3. Basic database skills, preferably in an electronic medical system.
4. Knowledge of insurance company processes and ability to read an Explanation of Benefits form.
5. Ability to work independently.

Patient Service Representative, page two of three

1. Ability to clearly communicate, both in writing and verbally.
2. Excellent interpersonal skills with a variety of personality types.
3. Ability to multi-task.
4. Ability to problem solve.
5. Organizational skills.

Physical Requirements:

Amount of Time

Activity

None

Under 1/3

1/3 2/3

Over 2/3


Stand

X


Walk

X

Sit

X

Use hands to finger, handle or feel

X

Reach with hands, arms

X

Climb or balance

X

Stoop, kneel, crouch

X

Push, pull, lift

X

Talk or hear

X

Travel:

(_X_) No travel between offices is required.

(___) Travel between or to different offices may be required.

Supervision Received:

Works independently with minimal supervision.


Supervisory Responsibilities:

(_X_) No Supervisory responsibilities


(___) Yes, this position supervises the following positions/departments (and approximate number of staff):

Key Relationships:

Internally builds and maintains relationships with assigned physician and work team, co-workers within department and co-workers outside of department. Externally maintains relationships with patients, caregivers and referring physicians. Employee works with the public and must be customer focused and pleasant at all times when dealing with patients, family members, coworkers and physicians. Employee works in a shared office space and may be required to move locations to access necessary information. Tasks can be overwhelming and employee must be able to prioritize and inform supervisor when difficulties and or delays arise. Works alone and with others; has face-to-face contact.


IV. KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

1. Mental Skills: Clerical; memorization; repetition; organization; analyzing; perception/comprehension; math skills; judgment; decision-making; socialization; attention to detail and communication/poise. Supervisory positions requires the understanding of complex reading and writing, and ability to demonstrate strong analytical and project management skills.
2. Interpersonal Skills: Demonstrates active listening techniques; gains support through effective relationships; treats others with dignity and respect; seeks feedback.
3. Technology Skills : Effectively uses all technologies provided; demonstrates proficiency in various commercial software programs including Microsoft Word, Excel, PowerPoint and Outlook as required for the position, electronic health record systems, document management, time management, payroll, HRIS and benefit enrollment systems.

Patient Service Representative, page three of three

1. Technology Skills : Effectively uses all technologies provided; demonstrates proficiency in various commercial software programs including Microsoft Word, Excel, PowerPoint and Outlook as required for the position, electronic health record systems, document management, time management, payroll, HRIS and benefit enrollment systems.
2. Customer Service Skills: Actively listens to internal and external customers and responds in a helpful, professional and timely manner to provide a consistent patient experience.
3. Communication Skills: Position requires ability to read, write, and communicate in English; ensures that all communications, whether written or verbal, are clear, complete and concise. Supervisors may be asked to present information in front of teams, management, doctors or company-wide.
4. Leadership Skills for Supervisors: Demonstrates willingness to try new tasks, generates new ideas for change, evaluates and recognizes priorities; challenges others to learn; keeps current and integrates new information; communicates and models organization values; and fosters high performance.

V. WORKING CONDITIONS:

Employee works with the public and must be customer focused and pleasant at all times when dealing with patients, family members, coworkers and physicians. Employee works in a shared office space and may be required to move locations to access necessary information. Tasks can be overwhelming and employee must be able to prioritize and inform supervisor when difficulties and or delays arise. Works alone and with others; has face-to-face contact; works inside; works around office equipment; works around electrical equipment.

Minimal or no exposure to adverse conditions.


VI. R EMARKS:

In addition to the specific tasks identified above, the expectation is that this is a full-time position, unless specifically identified as part-time, working within assigned work hours of the office and/or department (minor variances expected). The employee in this role is expected to perform quality work within deadlines, interact professionally and respectfully, work effectively as a team and independently as appropriate, always follow the code of conduct and all Horizon policies and procedures. The employee will also abide by Horizon training guidelines under the Compliance Program, and will remain compliant to its components including OSHA, HIPAA, Centers for Medicare and Medicaid Services, Managed Care Contracts, and North Carolina and federal laws.

While this is intended to be an accurate reflection of the current job, this is not necessarily an all-inclusive list of tasks and working conditions associated with the job. Management reserves the right to revise the job or to require that other or different tasks be performed when circumstances change (i.e., changes in personnel, workload, or technological developments) based on business need.


Employee Acknowledgement:

I understand the job description and requirements, and that I am expected to complete all duties as assigned. I understand the job duties may be altered from time to time. I have noted below any accommodations that are required to enable me to perform these duties. I have also noted below any job duties that I am unable to perform, with or without accommodation.

Employee Printed Name:


Employee Signature: Date: