Patient Service Representative I Patient Placement | PRN

American Addiction Centers•Macon, GA

2d•$21 - $31•Onsite

About The Position

Responsible for performing all job duties in a way that conforms to our customer service philosophy and consistent with our "AIDET" standards. This includes greeting and acknowledging patients and family members, introducing them to services, providing information on expected duration of care, explaining the need for demographic, socio-economic, and financial information, and safeguarding patient information. The role also involves collecting co-insurance and co-payments, identifying insurance coverage and benefits, and resolving issues related to patient eligibility and in-network status. For uninsured patients, the representative screens for urgent status, follows charity procedures, and refers patients for financial counseling. They also screen orders for compliance, communicate with physicians and care coordinators to resolve issues, and are responsible for security authorization and precertification of services. Additionally, the role involves identifying at-risk balances related to Medicare and Medicaid, communicating these to relevant departments, and initiating communication with patients regarding unauthorized services and potential financial impacts. The representative accurately collects and analyzes clinical data for prior authorization and precertification, maintains knowledge of insurance requirements and federal/state billing regulations, and ensures completion of policies for identification and notification of Primary Care Physicians for HMO coverage. They also inform relevant departments of out-of-network or non-covered service limitations. The role is responsible for pre-registration and registration accuracy, maintaining knowledge of state and federal regulations governing Medicare, Medicaid, and Mental Health registrations, and ensuring accurate entry of patient demographic and insurance information in the ADT system. This includes pre-registering and registering patients, educating them on documents requiring signatures, managing incoming and outgoing calls for pre-registrations, and generating/assembling required documents. The position also includes participation in departmental team building, in-services, and assisting leaders with special assignments.

Requirements

High School Diploma with 2 years of experience in either Patient Access or any of the following related experience; general physician office support or billing office, insurance office, hospitality, or call center (any industry)
Intermediate math skills acquired through classroom work or through work experience
Typing 25 WPM
Basic understanding of web-based systems, proficiency in data entry

Nice To Haves

Responsibilities

Greet and Acknowledge all patients and family members in a welcoming and prompt manner.
Introduce the patient to our services, what they can expect while under our care. Utilize appropriate etiquette in all communications.
Provide the patient with information on the likely time spent in the service area (duration) including time in registration and time in clinical service.
Explain the nature of our work, why we ask for demographic, socio-economic, and financial information. Explain how we safeguard their information and use it to provide better care for them.
Hand patients off to the next area with a clear "thank you."
When creating new registrations for walk-in patients, responsible for the identifying insurance coverage, the benefits available, patient out-of-pocket expenses, and collecting co-insurance and co-payments.
Collecting appropriate out of pocket expenses in accordance with policy.
Uses electronic systems to confirm coverage while patient is present and discussing the findings with the patient.
Follow established department policies to resolve issues related to patient's eligibility for coverage or issues in in-network status for the patient using Advocate's network.
When working uninsured patients, screen for urgent status cases and follow charity procedure. Refer as appropriate for additional financial counseling.
Engage leaders to resolve questions on urgent versus non-urgent/elective care.
When assisting walk-in patients, screen orders for compliance with policy.
Work with physicians, Care Coordinators, and clinical department leaders to communicate and resolve issues related to order quality and acceptable standards.
Responsible for security authorization and precertification of inpatient and outpatient services.
Notify Financial Counseling, physicians, Care Coordinators, and Utilization Management on cases were patients are found to be uninsured, or where the only insurance is Third Party Liability or Workers Compensation
Maintains knowledge of all stand-alone computer software programs to verify eligibility.
Identify at risk balances related to Medicare co-days, lifetime reserve days and other Medicare coverage limits and communicate to Financial Counseling, UM and physicians
Identify at risk balances relate to Medicaid eligibility rules and communicate to Financial Counseling, UM and physicians
Initiates communication to patient when authorization is not obtained and explain the potential financial impact and the patient responsibility for unauthorized services
Accurately collects and analyzes clinical data in support of prior authorization, and precertification as required by payor guidelines
Acquires and maintains current knowledge of all insurance requirements as it relates to patient/hospital responsibility and hospital billing.
Stays current of all Federal and State regulations regarding billing.
Ensures completion of all established policies and procedures for identification and notification of the Primary Care Physician in the case of HMO coverage plans.
Informs Financial counseling, physicians, Care Coordinators and Utilization Management of out of network or noncovered service limitations of managed care/commercial insurance where benefits are at risk
Responsible the pre-registration and registration accuracy.
Maintains knowledge of State & Federal regulations governing Medicare, Medicaid and Mental Health registrations.
Ensure accurate entry of patient demographic, insurance information in the ADT system with special attention to carrier code assignment, complete benefit, eligibility record and authorization data
Pre-registers and registers patients using established procedures for computer entry for all ancillary and nursing units, keeping current with their specialized needs and preparing necessary documents/records when necessary.
During the pre-registration or registration encounter, provide detailed education to the patient the contents of documents and forms requiring patient signature.
Manage incoming and outgoing calls in order to complete pre-registrations with patients
Generates, assembles and processes all required documents for completion of each registration.
Participates in departmental team building activities and in-services and other miscellaneous duties as assigned by leader.
Contributes to the quality initiatives and mission by participating in team projects.
Attends all required departmental in-services to stay current of all job changes and responsibilities.
Assist leader in special assignments as may be needed to fulfill the mission of the department and the organization.
Performs Computerized Provider Order Entry (CPOE) for exams accurately and completely to transcribe written physician orders. Seeks clarification from technician and physician if needed.
Performs light duty cleaning of changing areas as needed.
Prints patient’s results CDs when required and distributes finished exam results CD to patient while complying with application HIPAA considerations.
Escorts patients to changing areas as needed.

Benefits

Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program