Patient Services Representative II

EDUCATION/EXPERIENCE:

• High school diploma or equivalent and three years of experience working in a role within a customer service, fast paced environment with high volume of either calls or in-person requests; or an equivalent combination of education and experience

REPORTS TO:

• Supervisor, Clinic Registration

LICENSURE, CERTIFICATION, and/or REGISTRATION:

• N/A

ESSENTIAL FUNCTIONS:

1. Interview patients in-person and/or by phone to obtain all required information for hospital records and billing systems. Pre-registers all scheduled patients for admission, partial hospitalization, and outpatient services according to department policies and procedures.
2. Verify insurance coverage and obtains authorization for all services requiring pre-certification.
3. Process internal and out-going referrals, as needed, per department procedures
4. Perform clerical functions as needed, including answering phones, taking messages, chart processing, faxing and scanning.
5. Collect and process upfront deposits or set-up payment arrangements, as required.
6. Screen patient for Medicaid, Affordable care Act or hospital sponsored financial program and provides appropriate documentation and referral.
7. Assist other team members where necessary
8. Adhere to department policies and procedures related to verification of eligibility, benefits, pre-authorization requirements, available payment options, financial counseling and other identified financial clearance related duties
9. Complete assigned registration functions within multi-specialty clinic and/or emergency department, which may include claim edit work queues, pre-certifications and authorizations.
10. The Patient Services Representative III is expected to sequence multiple physician visits and complete registration activities within multiple registration platforms
11. Assists team with escalated issues, trains other team members as needed and is a subject matter expert.
12. Participate in departmental performance improvement initiatives
13. Other duties as assigned or requested by Supervisor or Manager, such as acting as back up in other departments
14. Understand and maintain operations knowledge of Medicare and other state and federal government payor compliance requirements for the population served.

SKILLS & QUALIFICATIONS

• EPIC Cadence experience preferred.
• Expert knowledge of patient access services and the overall effect on the revenue cycle.
• A thorough understanding of commercial and government insurance plans, payer networks, government resources and medical terminology.
• Understand and maintain operations knowledge of Medicare and other state and federal government payor compliance requirements for the population served.
• Demonstrated proficiency in communicating effectively with a customer and simplifying complex information.
• Demonstrated ability of critical thinking skills and adhering to compliance protocols.
• Demonstrated ability to handle escalated issues, train/mentor other team members and viewed as a subject matter expert.
• Ability to navigate Internet Explorer and Microsoft Office Suite of applications.
• Experience working in a role that requires prioritization of multiple critical priorities while ensuring quality and achievement of performance metrics.
• Demonstrated ability to meet or exceed performance metrics.
• Ability to handle sensitive information and maintain HIPAA compliance.

WORK ENVIRONMENT:

• Clean, indoor environment
• Minimal travel to clinic locations where assistance is needed

PHYSICAL REQUIREMENTS:

Amount of time spent performing the following activities: