Outpatient Services Rep

Job Title

Under the general supervision of, but according to established policies and procedures, the incumbent performs various administrative duties to expedite each patient's visit for clinical care. These duties include preparation of patient records; registration and pre-registration activities; problem resolution; appointment scheduling; and, co-payment preparation and collection. In addition, ancillary duties performed provide tracking and status of follow-up care as it pertains to specific diagnostic coding, billing/payment resolution, and generation of system reports, which reflect scheduling activities. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate

Responsibilities

1. Schedules patients using the hospital's scheduling system. This includes establishing the appointment type, specific provider clinic, and appointment time. Schedules follow-up appointment using the on-line scheduling system. May schedule appointments for patients who need lab work, diagnostic imaging or referral to other medical providers. Refers technical/clinical inquiries to appropriate personnel. Utilizes the on-line billing system to enter diagnosis/service codes from encounter sheets. This includes accurately entering the appropriate code in the hospital's billing system.

2. Completes pre-registration and registration process using the on-line billing system. Verifies demographic data, insurance authorization information, co-pays and physician. Collects co-payments and provides patients with receipts. Produces registration cards using the on-line system and card embosser. Photocopies front and back of insurance card. Confirms patient eligibility with insurance carriers and obtains visit authorizations as necessary. Provides mature, quality customer service to patients, their families and/or their representatives.

3. Mails informational material to new patients in advance of scheduled appointments. As necessary, contacts agencies outside the Hospital to obtain pertinent patient information and to coordinate clinic/treatment programs. Contacts third party payors to obtain required pre-authorizations in accordance with established policies.

4. Acts as an outpatient center receptionist. Makes telephone calls to patients as appointment reminders. Answers incoming calls. Returns phone calls to patients, physician offices and other medical providers such as laboratory and radiology facilities. Greets arriving patients and verifies pertinent information and physician using the online billing system. Orients patients to the specific outpatient center as a hospital-based service. Interacts effectively with patients and their family members.

5. Handles coding/billing within parameters as outlined in the department guideline. Using the on-line billing system enters diagnosis codes/service codes from encounter sheets. Verifies the appropriateness of the diagnostic code prior to entering in the billing system. Interacts with patients and Patient Financial Services in order to resolve billing issues, including denials. Appropriately refers patients to patient advocate for financial counseling.

6. Obtains and organizes medical records for use by physicians and nurses. Ensures patient's file is complete prior to treatment/clinic visit including appropriate records, lab test results and x-rays. Evaluates file prior to schedule visit and follows up with other Hospital departments to obtain missing data.

7. Prints reports using both the online scheduling and billing systems.

8. Performs all duties in accordance with RIH's mission, the defined role of ambulatory care, and defined administrative/clerical rules, procedures and policies.

9. May respond to telephone calls/inquiries by rotating into a centralized setting (i.e., a call room).

Minimum Qualifications

Basic Knowledge:

High School Diploma or equivalent. Demonstrated knowledge of PC skills using the windows operating system environment and accompanying software packages. Must have knowledge of medical billing routines for physician office practice. Must also have knowledge of medical terminology, diagnosis codes, and procedure codes. Must use and have knowledge of courteous telephone technique and good customer service skills.

Experience:

Six months experience coding and billing using online billing system.

Work Environment and Physical Requirements

Walking, sitting, standing throughout the day in clinic setting.

Independent Action

Performs independently within department policies and practices. Refers specific complex problems to supervisor where clarification of departmental policies and procedures may be required.

Supervisory Responsibility

None.