Patient Service Representitive

Advocate Health and Hospitals Corporation•Elgin, IL

5d•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 role involves greeting patients, explaining services, managing registration, collecting payments, verifying insurance, and ensuring compliance with policies and regulations. The position also requires participation in departmental team building activities and inservices. Additional duties may be required for offsite imaging centers, including CPOE, light cleaning, printing/distributing CDs, and escorting patients.

Requirements

High School Diploma
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

Responsibilities

Greet and acknowledge all patients and family members in a welcoming and prompt manner.
Introduce the patient to our services and what they can expect while under our care, utilizing 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, and how their information is safeguarded and used to provide better care.
Hand patients off to the next area with a clear "thank you."
When creating new registrations for walk-in patients, identify insurance coverage, available benefits, patient out-of-pocket expenses, and collect co-insurance and co-payments.
Collect appropriate out-of-pocket expenses in accordance with policy.
Use electronic systems to confirm coverage while the patient is present and discuss 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 with uninsured patients, screen for urgent status cases and follow charity procedures. 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 where patients are found to be uninsured, or where the only insurance is Third Party Liability or Workers Compensation.
Maintain knowledge of all stand-alone computer software programs to verify eligibility.
Identify at-risk balances related to Medicare co-pays, lifetime reserve days, and other Medicare coverage limits and communicate to Financial Counseling, UM, and physicians.
Identify at-risk balances related to Medicaid eligibility rules and communicate to Financial Counseling, UM, and physicians.
Initiate communication to the patient when authorization is not obtained and explain the potential financial impact and the patient responsibility for unauthorized services.
Accurately collect and analyze clinical data in support of prior authorization and precertification as required by payor guidelines.
Acquire and maintain current knowledge of all insurance requirements as it relates to patient/hospital responsibility and hospital billing.
Stay current with all Federal and State regulations regarding billing.
Ensure completion of all established policies and procedures for identification and notification of the Primary Care Physician in the case of HMO coverage plans.
Inform Financial Counseling, physicians, Care Coordinators, and Utilization Management of out-of-network or non-covered service limitations of managed care/commercial insurance where benefits are at risk.
Responsible for pre-registration and registration accuracy.
Maintain knowledge of State & Federal regulations governing Medicare, Medicaid, and Mental Health registrations.
Ensure accurate entry of patient demographic and insurance information in the ADT system with special attention to carrier code assignment, complete benefit, eligibility record, and authorization data.
Pre-register and register 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 on the contents of documents and forms requiring patient signature.
Manage incoming and outgoing calls in order to complete pre-registrations with patients.
Generate, assemble, and process all required documents for completion of each registration.
Participate in departmental team building activities and inservices and other miscellaneous duties as assigned by leader.
Contribute to quality initiatives and mission by participating in team projects.
Attend all required departmental inservices 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.
Perform Computerized Provider Order Entry (CPOE) for exams accurately and completely to transcribe written physician orders. Seek clarification from technician and physician if needed.
Perform light duty cleaning of changing areas as needed.
Print patient's results CDs when required and distribute finished exam results CD to patient while complying with applicable HIPAA considerations.
Escort patients to changing areas as needed.