Patient Services Representative III

First Choice Community Healthcare•Los Lunas, NM

7d•Onsite

About The Position

The Patient Services Representative III (PSR III) plays a crucial role in ensuring that all claims from their site locations are paid, aiming for a very low percentage of denied claims. This position is responsible for verifying that PSRs at their site are correctly completing the registration and verification process to result in payable encounters, and will regularly report findings to their Health Center Manager (HCM). Under the close supervision of the HCM and in coordination with Dental Central Billing, the PSR III must be proficient in all PSR II competencies. Key responsibilities include greeting patients and visitors, registering new and returning patients, collecting payments, setting up payment plans for self-pay patients, and thoroughly reviewing all dental insurance benefits (including limitations, deductibles, co-insurances, and wait periods). The PSR III must be able to explain these details to patients in simple terms. Proficiency in understanding dental coding, payments, adjustments, and reading the Dentrix ledger is essential. This role also involves managing a self-pay and insurance Accounts Receivable (AR) for a minimum of 90 days to prevent claims from becoming "timely" (i.e., exceeding submission deadlines). The PSR III must understand the status of every dollar in the AR for their site, maintain regular documentation on claim status, and know when to consult the Dental Central Billing Team. Daily tasks include preparing the daily deposit and the daily batch for Dental Central Billing. All interactions must be supportive and responsive to patients and visitors. Additionally, the PSR III is expected to have a level of Dental Billing experience that enables clear communication with the Dental Central Billing Department, providers, and patients regarding their bills, processes, and account outcomes. A PSR II will cover this position when the PSR III is away.

Requirements

High School graduate or GED certificate
Two years of onsite dental billing experience
Must possess all PSR II knowledge
Must possess the ability to accurately understand dental benefit knowledge and the ability to articulate them to patients in layman’s terms, with ease.
Knowledge of patient registration/billing/collections, procedures, and documentation.
Receptionist skills.
Knowledge of applicable FCCH patient-related forms and programs.
Ability to interact and communicate with people over the telephone, often in stressful situations.
Knowledge of planning and scheduling techniques.
Knowledge of pre-certification requirements, procedures, and documentation of third-party medical insurance payors or other patient healthcare funding programs.
Ability to analyze and solve problems.
Skill in the use of personal computers and related software applications.
Appropriate knowledge and familiarity with various compliance programs and elements.
Cooperate fully and comply with applicable laws and regulations.
Ability to maintain quality, safety, and/or infection control standards.
Basic knowledge of general office procedures to include filing, copying, and faxing.
Ability to use a multi-line telephone to schedule appointments.
Ability to use a computer to enter patient data and retrieve information to generate reports and payment receipts.
Ability to work on multiple tasks within established deadlines.
Ability to work under the direction of a supervisor and follow instructions for work completion.
Ability to take the initiative to resolve patient concerns and problems.
Able to work well with diverse groups of people.
HIPAA Educated.

Nice To Haves

Bi-lingual English/Spanish is preferred.

Responsibilities

Ensure all claims from site locations are paid, aiming for a very low percentage of denied claims.
Verify that PSRs at the site are correctly completing the registration and verification process.
Report findings on registration and verification to the Health Center Manager regularly.
Greet patients and visitors entering the health center.
Register new and returning patients.
Collect payments from patients for their visits.
Place self-pay patients on payment plans.
Review all dental insurance benefits, including frequency limitations, deductible, co-insurances, and wait periods.
Articulate insurance benefit details to patients in layman's terms.
Comprehend dental coding, payments, and adjustments, and read the Dentrix ledger.
Manage an AR (self-pay and Insurance) for a minimum of 90 days to ensure no claims go "timely" at the site.
Understand the status of every dollar on the AR for the site.
Answer questions about accounts and keep regular documentation on claim status.
Assist patients with account questions and know when to consult the Dental Central Billing Team.
Prepare the daily deposit and the daily batch for Dental Central Billing.
Greet new and returning patients and clients and check them in for appointments.
Update patient records to verify contact information.
Greet other visitors to the health center and direct them appropriately.
Provide general information concerning FCCH functions.
Answer the telephone and connect callers to the appropriate offices or staff.
Schedule new and return appointments over the telephone and in person.
Pull and file dental charts when necessary.
Collect required personal, health, and insurance information for the permanent patient record.
Enter accurate patient data into the computer system daily.
Collect patients’ copay/coinsurance/deductible/deposit at time of service.
Maintain an accurate, balanced, locked cash bag/box and reconcile daily cash receipts.
Verify insurance eligibility for Medicaid, Medicare, and third-party payors.
Verify personal income according to established guidelines.
Follow appropriate computer downtime procedures.
Scan patient registration documents as directed.
Merge duplicate patient files in PWPM, if assigned.
Answer telephone billing inquiries and resolve problems in a timely manner.
Maintain a daily record of all billing receipts and prepare the bank deposit and cash reconciliation report.
Assist the Health Center Manager with collection calls and letters.
Work closely with the Dental Central Billing office in all aspects of billing/collections.
Consistently follow checkout guidelines after a dental appointment.
Check the document center to ensure all necessary documentation for the encounter is collected.
Check to ensure a procedure has been charged by a provider.
Check to ensure diagnosis codes are in the system.
Check for any outstanding claims and bring them to the attention of Dental Central Billing.
Check for any outstanding balances and ensure an active payment plan is in place if necessary.
Collect payment.
Check to ensure the next appointment is fully approved and payable by the insurance company, and make proper arrangements if not.
Attend billing meetings with the Dental Operations Manager and Dental Central Billing Manager regularly.
Stay in close communication with the Dental Central Billing Team when needed.
Research a claim to get claim status when needed.
Recognize when referral assistance is needed and the need for a DPCF referral.
Track site errors and conduct meetings with PSR I’s and II’s at the site when needed.
Audit patient statements prior to them being sent, upon request by the HCM.
Other duties as assigned.