Patient Service Representative - Prior Authorization- Nephrology

Springfield Clinic•Springfield, MO

13h•Onsite

About The Position

The Patient Service Representative - Prior Authorization is responsible for discussing insurance coverage, including usual and customary charges, Medicare and Medical Assistance availability, and reimbursement options for services. This role involves educating patients on the Clinic's billing and credit policies, working with patient insurance carriers to verify benefits coverage for treatment, and addressing any credit concerns regarding past due accounts to ensure timely payment. The position requires empathy and responsiveness to patients while adhering to Patient Accounting billing practices and guidelines. The representative may also be required to provide coverage at other Springfield Clinic locations.

Requirements

High School graduate or GED required.
Ability to handle multiple tasks and prioritize in a fast-paced environment required.
Strong verbal communication and listening skills are required.
Knowledge of the computer systems with emphasis on registration and insurance screens.
Knowledge of Medicare, medical assistance and other third party payors.
Ability to work with patients of all ages in a courteous and professional manner.
Must be empathetic, yet responsive to Patient Accounting billing policies and guidelines.
Ability to tactfully work with patients with past due accounts.
Ability to meet quality and performance guidelines and work with patients in a courteous and professional manner.
Must have the ability to maintain composure under stress.
Manual dexterity required for use of telephone headset, calculator and computer keyboard.

Nice To Haves

Minimum two to three (2-3) years experience in medical billing and insurance preferred.
Computer skills, including Microsoft Office, preferred.

Responsibilities

Verify coverage and benefits prior to treatment.
Secure prior-approval and pre-authorizations.
Maintain proficiency with insurance and billing issues and serve as a resource to providers and staff.
Provide a positive impression to patients about the Clinic's billing department.
Enter/edit patient insurance coverage/demographic information when necessary.
Answer questions that patients may have in regard to insurance coverage and other billing issues.
Respond to patient's verbal and written requests in a timely fashion.
Maintain statistics.
Maintain proficiency with insurance and billing issues by participating in Patient Accounting meetings and training sessions as appropriate.
Must be empathetic, yet responsive to patients while adhering to Patient Accounting billing practices and guidelines.
Provide coverage at other Springfield Clinic locations as assigned.
Comply with the Springfield Clinic incident reporting policy and procedures.
Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
Perform other job duties as assigned.