Patient Services Representative II

Advocate Health and Hospitals Corporation•Greensboro, NC

1d•Onsite

About The Position

The Patient Services Representative II is responsible for interviewing patients to gather necessary information for hospital records and billing systems, pre-registering scheduled patients, verifying insurance coverage, and processing referrals. This role also involves performing clerical duties, collecting upfront deposits or setting up payment arrangements, screening patients for financial assistance programs, and assisting team members. The position requires completing registration functions within multi-specialty clinics or emergency departments, including managing claim edits, pre-certifications, and authorizations. Additionally, the Patient Services Representative II is expected to assist with escalated issues, train other team members, and act as a subject matter expert. They will also participate in departmental performance improvement initiatives and may be asked to back up other departments. A key aspect of the role involves understanding and maintaining operational knowledge of Medicare and other state and federal government payor compliance requirements.

Requirements

High school diploma or equivalent
Three years of experience working in a role within a customer service, fast paced environment with high volume of either calls or in-person requests
EPIC Cadence experience preferred.
Expert knowledge of patient access services and the overall effect on the revenue cycle.
A thorough understanding of commercial and government insurance plans, payer networks, government resources and medical terminology.
Understand and maintain operations knowledge of Medicare and other state and federal government payor compliance requirements for the population served.
Demonstrated proficiency in communicating effectively with a customer and simplifying complex information.
Demonstrated ability of critical thinking skills and adhering to compliance protocols.
Demonstrated ability to handle escalated issues, train/mentor other team members and viewed as a subject matter expert.
Ability to navigate Internet Explorer and Microsoft Office Suite of applications.
Experience working in a role that requires prioritization of multiple critical priorities while ensuring quality and achievement of performance metrics.
Demonstrated ability to meet or exceed performance metrics.
Ability to handle sensitive information and maintain HIPAA compliance.

Responsibilities

Interview patients in-person and/or by phone to obtain all required information for hospital records and billing systems.
Pre-register all scheduled patients for admission, partial hospitalization, and outpatient services according to department policies and procedures.
Verify insurance coverage and obtains authorization for all services requiring pre-certification.
Process internal and out-going referrals, as needed, per department procedures.
Perform clerical functions as needed, including answering phones, taking messages, chart processing, faxing and scanning.
Collect and process upfront deposits or set-up payment arrangements, as required.
Screen patient for Medicaid, Affordable care Act or hospital sponsored financial program and provides appropriate documentation and referral.
Assist other team members where necessary.
Adhere to department policies and procedures related to verification of eligibility, benefits, pre-authorization requirements, available payment options, financial counseling and other identified financial clearance related duties.
Complete assigned registration functions within multi-specialty clinic and/or emergency department, which may include claim edit work queues, pre-certifications and authorizations.
Sequence multiple physician visits and complete registration activities within multiple registration platforms.
Assist team with escalated issues, trains other team members as needed and is a subject matter expert.
Participate in departmental performance improvement initiatives.
Other duties as assigned or requested by Supervisor or Manager, such as acting as back up in other departments.
Understand and maintain operations knowledge of Medicare and other state and federal government payor compliance requirements for the population served.