Patient Service Representative I PRN

American Addiction Centers•Concord, NC

21h•$21 - $31•Onsite

About The Position

The Patient Service Representative I (PRN) is responsible for performing all job duties in a way that conforms to our customer service philosophy and consistent with our "AIDET" standards. This role involves greeting and acknowledging patients and family members, introducing them to services, explaining what they can expect, and providing information on the likely time spent in the service area. The representative will explain the nature of the work, why demographic, socio-economic, and financial information is collected, and how it is safeguarded. They will also hand patients off to the next area with a clear "thank you." Key responsibilities include creating new registrations for walk-in patients, identifying insurance coverage, benefits, and patient out-of-pocket expenses, and collecting co-insurance and co-payments. This involves using electronic systems to confirm coverage, discussing findings with the patient, and following department policies to resolve eligibility or in-network status issues. For uninsured patients, the role includes screening for urgent status, following charity procedures, and referring for financial counseling. The representative will also screen orders for compliance, work with physicians and other leaders to resolve issues, and be responsible for security authorization and precertification of inpatient and outpatient services. They will notify relevant departments about patients who are uninsured or have specific insurance types, maintain knowledge of computer software for eligibility verification, identify at-risk balances related to Medicare and Medicaid, and communicate potential financial impacts to patients for unauthorized services. The role also involves collecting and analyzing clinical data for prior authorization and precertification, maintaining knowledge of insurance requirements, federal and state regulations, and ensuring completion of policies for Primary Care Physician notification for HMO coverage plans. Additionally, the representative will inform relevant departments about out-of-network or non-covered service limitations. Accuracy in pre-registration and registration is crucial, including accurate entry of demographic and insurance information, pre-registering and registering patients, educating patients on documents, managing calls for pre-registrations, and processing required documents. Participation in departmental team building, in-services, and other assigned duties is also expected.

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
Ability to prioritize and organize workload
Sophisticated interviewing, communication and negotiation skills
Independent decision making
Ability to work as a team member
Must be able to sit, stand, walk, lift, carry, squat, and bend frequently as well as twist, rotate, and kneel occasionally throughout the workday.
Frequently lifts up to 10 lbs. and occasionally lifts between 20 lbs. or more. This occurs when moving equipment and supplies and when transporting patients and/or charts.
Must be able to push/pull up to 50 lbs. with assistance.
Must have functional speech and hearing.
Must be able to use hands with fine motor skills for keyboard data entry.

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

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