Patient Services Representative - NBGW ENT (Full Time, Day)

NorthBay Healthcare Corporation•Fairfield, CA

About The Position

At Northbay Health, the Patient Services Representative III schedules surgeries and referrals in coordination with the care team and assists patients with financial clearance before, during, or after treatment. The role obtains and updates insurance, financial, and demographic information; helps patients and families understand options for covering financial obligations; establishes payment plans; and collects self-pay and residual balances as needed. It also provides assistance with patient financial issues and medical bills and serves as a liaison between patients and insurance companies to coordinate payments and answer questions. The representative supports both patient access and revenue-cycle processes by providing cost estimates, explaining payment and financial assistance options, negotiating payment arrangements, updating accounts, processing forms, and resolving billing questions or errors. The role coordinates surgery scheduling with surgeons and scheduling teams, schedules orthopedic referrals, collaborates with other departments to support continuity of care, assists other Patient Services Representatives, and takes on special projects and other assigned duties.

Requirements

At least two years of experience in a medical front-office setting, including experience and knowledge of health insurance and benefit requirements.
Two years of experience working with medical insurance plans.
At least two additional years of experience working with referrals or consultation processes in an ambulatory care setting.
Excellent customer service skills and comprehensive knowledge of revenue-cycle workflows and processes.
Excellent analytical and project management skills, with the ability to manage multiple projects and deadlines.
Good organizational skills; ability to work independently and prioritize multiple projects and objectives in a rapidly changing environment.
Ability to communicate clearly and effectively and relate cordially to coworkers, members, providers, and others.
Ability to download and save reports in Excel and sort reports by name, date, or descending dollar order.
Ability to determine appropriate actions and research needed to respond to questions from patients, providers, or payers.
Knowledge of medical terminology, CPT, ICD-10-CM, Revenue Codes, Medicare guidelines and regulations, billing and follow-up practices, billing requirements for all payer types, and managed-care terminology.
Knowledge of Cerner, Microsoft Outlook, Word, and Excel.
Adherence to established policies and procedures and attendance and punctuality standards.
Ability to meet the physical demands of prolonged standing and sitting, some walking, and extensive use of a telephone and computer keyboard.

Nice To Haves

High school graduation is preferred.
An associate degree or bachelor’s degree is preferred.

Responsibilities

Schedule surgeries and referrals in coordination with the care team, including elective and non-elective surgeries in the Ambulatory Surgery Center and OR.
Schedule referrals for orthopedic providers in the clinic.
Obtain and update patients’ insurance, financial, and demographic information.
Assist patients with financial clearance before, during, or after treatment.
Explain payment options and financial assistance, provide cost estimates, and offer guidance on medical bills.
Establish payment plans, negotiate payment arrangements, and collect self-pay and self-pay residual balances as necessary.
Address patient financial issues and liaise with insurance companies to coordinate payments and answer questions.
Update patient accounts and balances, and review and process patient and insurance company forms.
Communicate with patients, insurance companies, Ambulatory Surgery Center schedulers, and OR schedulers by phone.
Inform or update supervisory personnel about patient billing concerns.
Answer patient billing questions and work with ambulatory accounting or insurance companies to correct billing errors.
Communicate and collaborate with other departments to provide continuity of care across departments and disciplines.
Assist other Patient Services Representatives with their workload and provide support as needed.
Promote teamwork and maintain effective communication with internal and external customers.
Work on special projects or interdisciplinary committees as assigned, and perform other duties as assigned.