Patient Services Specialist

Patient Services Specialist

POSITION SUMMARY

Verifies insurance and sliding fee eligibility prior to patient appointments to reduce patient wait time. Corrects insurance prior to the visit to minimize claim denials and improve collections.

WHY LRMC

Little River Medical Center is a non-profit community health center within Horry County. At Little River Medical Center, we strive to offer exceptional health services and deliver quality, compassionate care to everyone. We provide a wide range of affordable health and support services for every family.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Monitor insurance plans to make sure they are properly set up to check eligibility.
• Maintain the system to optimize the eligibility process to include pointing the system to the payer websites to obtain additional patient insurance information that is needed regarding patient eligibility.
• Utilize the Eligibility Worklist that is run nightly for appointments two days ahead to confirm the insurance listed on the appointment scheduler is correct. Utilizing the schedule by provider will allow for verification of self-pay and sliding fee appointments in addition to the insurance appointments. Also, this process will allow for a better distribution of work to various staff.
• Communicates with patients regarding estimate inquiries and explanation of calculated services.
• Calculates an estimate of future patient services based on information recorded in the chart.
• Analyze visit type purposes in order to determine good faith estimate compliance requirements.
• Correct any errors in Patient Administration for incorrect demographics, co-pays, deductibles, co-insurance, insurance plans, etc.
• Assist with Dispute Resolution process for patient disputed Good Faith Estimates.
• Communicates with other departments regarding requested Good Faith Estimates.
• Adjust the ranking of the insurance plans: primary, secondary, tertiary, etc.
• Update insurance notes as needed. Keep notes current so that they are pertinent and easy to read.
• Knowledge of Sliding Fee Scales and the ability to apply them to Good Faith Estimates.

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.

• Basic understanding of medical terminology
• Basic understanding of Microsoft functions
• Basic understanding of ICD 10 Coding
• General knowledge of CPT codes and descriptions

EDUCATION and/or EXPERIENCE

• High School Diploma or Ged Required
• Medical billing & Eligibility experience Required.
• Experience in Family Medicine preferred.
• Experience with eClinicalWorks preferred.
• Community Health Center or FQHC experience helpful.

LRMC offers benefits such as:

• State Medical, Vision & Dental insurance.
• Employer matched 403B Retirement Plan.
• Paid Vacation time, Sick time, & Holiday's. As well as paid qualifying Administrative Leave.
• Employer Paid Health Benefits: Life / AD&D Policies, Short/Long Term Disability, and a Employee Assistant Plan.