PATIENT RESOURCE SPECIALIST

Memorial Health System • Lincoln, IL

240d

About The Position

The Patient Resource Specialist is responsible for creating an excellent impression of Lincoln Memorial Hospital's resources to patients, families, and other external customers over the phone or in person. They work collaboratively with patients, providers, colleagues, and insurance companies to ensure that patient needs are met. The Patient Resource Specialist coordinates and participates in a variety of duties as part of the pre-visit process, including patient identification, pre-registration, pre-authorization, and appointment scheduling. They provide payment options, collect balances due, and initiate referrals for financial assistance per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established procedures. The role also requires maintaining up-to-date knowledge of Joint Commission standards, Patient Rights and Responsibilities, HIPAA compliance, and health system policies.

Requirements

• High school diploma or GED equivalent required.
• Two (2) years of business office experience, preferably in Patient Access, billing, collections, insurance principles/practices, or accounts receivable.
• Three (3+) years of customer service experience required.
• Knowledge of medical terminology, CPT, HCPCS, CCI Edits, ICD-10 CM/PCS coding, Revenue Codes, UB-04, and EOB interpretation.
• Proficient computer skills with the ability to enter, retrieve, and notate data in patient accounting and related systems.
• Strong attention to detail, critical thinking, and problem-solving abilities.
• Excellent verbal and written communication skills.
• Ability to work effectively with both internal and external customers.
• Familiarity with state/federal regulations, insurance guidelines, and Joint Commission policies and procedures.

Nice To Haves

• Previous experience in Patient Financial Services is highly desirable.
• Medical terminology, medical office registration, or billing experience strongly preferred.
• CPSI/Evident systems experience preferred.

Responsibilities

• Assist customers and others regarding patient account issues, offering clear guidance and resolutions.
• Educate patients and others on billing resolution, private pay options, collection efforts, coordination of benefits, third-party and governmental payment criteria, insurance coverage, payments, and denials.
• Serve as a liaison between external resources, colleagues, and patients to ensure smooth communication and assistance.
• Demonstrate superior patient relations and interpersonal skills, maintaining a calm demeanor while dealing with patients, colleagues, and the general public.
• Coordinate accurate patient data collection to verify insurance eligibility and determine financial obligations, including collection of copayments and deductibles.
• Effectively negotiate with patients and families to explain, collect, and record patient payments and/or deposits.
• Process and reconcile cash, checks, credit card transactions, and bank loans as appropriate.
• Prepare bank deposits for pickup in accordance with departmental procedures.
• Effectively triage, document, and initiate referrals for financial assistance.
• Review and combine multiple financial accounts for individual patients.
• Research and resolve complex issues related to patient accounts.
• Record all customer visits accurately, ensuring proactive discussion of all the patient's accounts.
• Document all collection activities thoroughly and send daily payment reconciliation reports to the appropriate teams.
• Identify, prioritize, and resolve problematic accounts by reviewing, investigating, and verifying patient eligibility for payer sources and/or financial assistance.
• Coordinate with various departments to ensure accurate financial documentation.
• Work with clinical departments to obtain insurance authorizations, verifications, and pre-certifications for outpatient services as needed.
• Build strong relationships with assigned business units, hospital departments, or provider offices.
• Complete all steps of pre-registration and registration, verifying patient identity and demographic information.
• Orients and cross-trains other team members as directed by management.
• Coordinate patient or family requests for records with Health Information Management (HIM).
• Perform other related work as required or requested.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: High school or GED