Patient Services Representative III

First Choice Community Healthcare INC•Los Lunas, NM

8d•Hybrid

About The Position

The Patient Services Representative III (PSR III) plays a crucial role in ensuring that claims generated from their site locations are paid, aiming for a very low percentage of denied claims. This position acts as a primary source for verifying the accuracy of the registration and verification processes completed by PSRs at their site, reporting findings regularly to the Health Center Manager (HCM). Under the HCM's supervision 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 dental insurance benefits (including frequency limitations, deductibles, co-insurances, and wait periods). The role requires the ability to explain these details to patients in simple terms, comprehend dental coding, payments, and adjustments, and confidently read the Dentrix ledger. A significant aspect of the role is managing Accounts Receivable (AR) for both self-pay and insurance for a minimum of 90 days to prevent claims from becoming "timely" (past due). The PSR III must understand the status of every dollar on the AR for their site, maintain regular documentation on claim status, and assist patients with account questions, knowing when to consult the Dental Central Billing Team. Daily tasks include preparing the daily deposit and the daily batch for Dental Central Billing. The position requires 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 during absences.

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 patient 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. Cooperates fully and complies 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

Greets new and returning patients and clients entering the health center and checks them in for scheduled and walk-in appointments.
Updates patient records to verify contact information.
Greets other visitors to the health center and directs them to the appropriate offices or individual staff.
Provides general information to patients concerning functions of FCCH.
Answers the telephone and connects callers to the appropriate offices or individual staff.
Schedules new office appointments and return appointments over the telephone and in person.
Pulls and files dental charts when necessary.
Proficient in all dental billing practices.
Meets with patients to collect required personal, health, and insurance information for the permanent patient record.
Enters accurate patient data into the computer system daily.
Collect patients’ copay/coinsurance/deductible/deposit at time of service.
Keeps accurate, balanced, locked cash bad/box and is personally responsible for any imbalance in the daily reconciliation of cash receipts.
Verifies insurance eligibility for Medicaid, Medicare, and third-party payors.
Verifies personal income according to established guidelines for all patients.
Follows appropriate computer downtime procedures.
Scans patient registration documents as directed.
Merges duplicate patient files in PWPM, if assigned.
Verifies in detail all dental benefits to include frequency limitations, deductibles, wait periods, percentages of coverages per procedure.
Answers telephone billing inquiries and resolves problems in a timely manner.
Demonstrates ability to maintain daily record of all billing receipts and prepares the bank deposit and cash reconciliation report for the Finance department.
Assists the Health Center Manager with collection calls and letters.
Works closely with Dental Central Billing office in all aspects of billing/collections.
Responsible for maintaining a 90-day AR (Insurance and Self Pay), to ensure that no claim “goes timely” at the site and no patient balance is ignored.
Consistently follows the checkout guidelines when checking a patient out after a dental appt. to include, but not limited to- check the document center to ensure we have collected what we need to be paid for the encounter, check to make sure a procedure has been charged by a provider, check to make sure diagnoses codes are in the system, check for any outstanding claims (past) and bring those to the attention of Dental Central Billing, check for an outstanding balance and make sure we have an active payment plan if necessary, collect the payment, check to make sure the next appt. is fully approved, and payable by the insurance company and if it is not make the proper arrangements for the upcoming appointment.
Will with regularity attend billing meetings with the Dental Operations Manager and Dental Central Billing Manager.
Will stay in close communication with the Dental Central Billing Team, when needed.
Ability to research a claim to get claim status, when needed.
Ability to recognize when referral assistance is needed and the ability to recognize the need for a DPCF referral.
Will track your site errors and conduct meetings with PSRI’s and II’s at your site when needed.
Upon request by the HCM this position will be required the auditing some pt. statements prior to them being sent.
Other duties as assigned.