Patient Services Representative II

Advocate Health•Winston-Salem, NC

1d•$22 - $33•Onsite

About The Position

The Patient Services Representative II interviews patients in person or by phone to collect information for hospital records and billing systems, and pre-registers patients for scheduled admissions, partial hospitalization, and outpatient services. The role verifies insurance coverage, obtains required authorizations, processes referrals, performs clerical and registration functions, and collects deposits or arranges payments. It also screens patients for Medicaid, Affordable Care Act, and hospital-sponsored financial programs and provides appropriate documentation and referrals. The position supports patient access operations across multi-specialty clinics and/or emergency departments, including registration activities, claim edit work queues, pre-certifications, and authorizations. The representative assists teammates with escalated issues, trains and mentors others as needed, serves as a subject matter expert, participates in performance improvement initiatives, and maintains knowledge of applicable Medicare and other government payer compliance requirements. The work is performed in a clean indoor environment, with minimal travel to clinic locations where assistance is needed.

Requirements

High school diploma or equivalent and three years of experience in customer service in a fast-paced environment with a high volume of calls or in-person requests, or an equivalent combination of education and experience.
Expert knowledge of patient access services and their overall effect on the revenue cycle.
Thorough understanding of commercial and government insurance plans, payer networks, government resources, and medical terminology.
Knowledge of Medicare and other state and federal government payer compliance requirements for the population served.
Demonstrated ability to communicate effectively with customers and simplify complex information.
Demonstrated critical-thinking skills and ability to adhere to compliance protocols.
Ability to handle escalated issues, train or mentor team members, and serve as a subject matter expert.
Ability to navigate Internet Explorer and Microsoft Office Suite applications.
Experience prioritizing multiple critical priorities while maintaining quality and meeting performance metrics.
Demonstrated ability to meet or exceed performance metrics.
Ability to handle sensitive information and maintain HIPAA compliance.

Nice To Haves

EPIC Cadence experience.

Responsibilities

Interview patients in person and/or by phone to obtain required information for hospital records and billing systems.
Pre-register scheduled patients for admission, partial hospitalization, and outpatient services according to department policies and procedures.
Verify insurance coverage and obtain authorization for services requiring pre-certification.
Process internal and outgoing referrals as needed according to department procedures.
Perform clerical functions, including answering phones, taking messages, processing charts, faxing, and scanning.
Collect and process upfront deposits or set up payment arrangements as required.
Screen patients for Medicaid, Affordable Care Act, or hospital-sponsored financial programs and provide appropriate documentation and referrals.
Assist other team members where necessary.
Follow department procedures for eligibility and benefit verification, pre-authorization requirements, payment options, financial counseling, and other financial clearance duties.
Complete assigned registration functions within multi-specialty clinics and/or emergency departments, which may include claim edit work queues, pre-certifications, and authorizations.
Assist the team with escalated issues, train other team members as needed, and serve as a subject matter expert.
Participate in departmental performance improvement initiatives.
Perform other duties as assigned or requested by a supervisor or manager, including serving as backup in other departments.
Maintain operational knowledge of Medicare and other state and federal government payer compliance requirements for the population served.