Patient Services Representative, Ophthalmology, FT, Days

Prisma Health•Columbia, SC

1d•Onsite

About The Position

Responsible for aspects of front office management and operation as assigned. This role involves complete and accurate patient registration, pre-certification, charge capture, and accurately coding diagnoses given by physicians. The representative is responsible for posting all payments and balancing with computer reports at day end. This position requires a high level of public contact and excellent interpersonal skills. The role involves arranging for patient pre-payments and enforcing financial agreements prior to providing service. Responsibilities include gathering charge information, coding, entering into the database, completing the billing process, and distributing billing information. The representative will file insurance claims, assist patients in completing insurance forms, and process unpaid accounts by contacting patients and third-party payers. This role serves as a liaison between the patient and medical support staff, greeting patients and visitors courteously, checking them in, and verifying/updating insurance information. Obtaining necessary signatures, assisting patients with ambulatory difficulties, and maintaining the appointment book are also key functions. The role provides front office phone support, screens visitors, and responds to routine information requests. The representative is responsible for gathering, accurately coding, and posting outpatient charges, processing vouchers and private payments, and researching address verification. They will help process mail return statements and outgoing statements, acquire billing information for all doctors for all patients, and perform cashiering functions including monitoring and balancing the cash drawer daily, preparing daily cash deposits, and receiving payments from patients. The representative will work with patients in securing prepayment sources or financial agreements, participate with other staff to achieve account resolution, and assist with outpatient coding and error resolution. They will process edits and Customer Service and Collection Requests within specified time frames, identify trends, and communicate problems to management. Updating the patient account database, maintaining and updating physician’s schedules, and scheduling surgeries, ancillary services, and follow-up appointments are also part of the role. Answering questions regarding appointments and testing, assembling patient charts, updating patient profiles, and overseeing the waiting area are included. The representative will assist patients with questions on insurance claims, disability benefits, home health care, medical equipment, and surgical care. They will process benefit correspondence, signatures, and insurance forms to expedite payment of outstanding claims and assist patients in completing forms for hospitalization or surgical pre-certification. Following up with insurance companies to ensure coverage approval, posting all actions, and maintaining permanent records of patient accounts are essential. Answering patient questions and inquiries regarding their accounts, confirming workers’ compensation claims, and preparing disability claims are also required. The representative will follow up with insurance companies to ensure claims are paid, maintain files with referral slips, medical authorizations, and insurance slips, and research information needed to complete outpatient billing. Coding procedure and diagnosis information, keying charge information into an online entry program, and processing/distributing billings are part of the role. Pulling charts in advance, delivering, transporting, sorting, and filing returned charts, and picking up lab reports, dictations, X-rays, and correspondence are also duties. Maintaining orderly files, filing all medical reports, purging obsolete records, and destroying outdated records following established procedures are necessary. Making new patient charts, repairing damaged charts, and assisting in locating and filing records are included. The representative will work with medical assistants and other staff to route patient charts and follow medical records policies. Collecting payments at the time of service, reviewing accounts for timely payment, performing collection actions, and evaluating patient financial status to establish payment plans are key responsibilities. Identifying and resolving patient billing complaints and participating with other staff to follow up on accounts until zero balance or turned over for collection are also part of the role. The representative will participate in educational activities, gather and verify superbills, and enter charge and payment information, verifying accuracy. Printing daily reports, verifying charge entry balancing, backing up and closing computer files daily, and registering new patients are also duties. Maintaining strict confidentiality and performing other related work as required are expected. As a representative of Prisma Health Clinical Department, maintaining a neat and professional appearance, demonstrating commitment to serve, and upholding guidelines set forth in the office manual are essential.

Requirements

High school diploma or equivalent OR Post-high school diploma.
No previous experience required.
Basic understanding of ICD-9 and CPT coding preferred.

Nice To Haves

Associate degree in technical specialty program of 18 months minimum in length preferred
Multi-specialty group practice setting experience preferred
In lieu of education requirements, current Prisma Health team members with 1 year of Prisma Health experience in this job profile will be accepted.

Responsibilities

Responsible for complete and accurate patient registration, pre-certification, charge capture and accurately coding diagnoses given by physicians.
Responsible for posting all payments and balancing with the computer reports at day end.
Arranges for patient pre-payments and enforces financial agreements prior to providing service.
Gathers charge information, codes, enters into database, completes billing process, distributes billing information.
Files insurance claims and assists patients in completing insurance forms.
Processes unpaid accounts by contacting patients and third-party payers.
Greets patients and visitors in a prompt, courteous, and helpful manner.
Checks in patients, verifies and updates necessary insurance information in the patient accounting system.
Obtains signatures on all forms and documents as required.
Assists patients with ambulatory difficulties.
Maintains appointment book and follows office scheduling policies.
Provides front office phone support as needed and outlined through cross training program.
Screens visitors and responds to routine requests for information.
Responsible for gathering, accurately coding and posting outpatient charges.
Processes vouchers and private payments, to include updating registration screens based on information on checks.
Research address verification as needed.
Helps to process mail return statements and outgoing statements.
Acquires billing information for all doctors for all patients seen in practice.
Performs cashiering functions including monitoring and balancing cash drawer daily.
Prepares daily cash deposits.
Receives payments from patients and issues receipts.
Codes and posts payments and maintains required records, reports and files.
Works with patients in securing prepayment sources or financial agreements prior to providing service.
Participates with other staff to achieve account resolution.
Assists with outpatient coding and error resolution.
Processes edits and Customer Service and Collection Request for resolution within specified time frames.
Identify trends and communicates problems to management.
Updates patient account database.
Maintains and updates current information on physician’s schedules.
Schedules surgeries, ancillary services and follow-up outpatient appointments and admissions as requested.
Answers questions regarding patient appointments and testing.
Assembles patients’ charts for next day visit.
Updates profiles on all patients, ensuring completeness and accuracy.
Oversees waiting area, coordinates patient movement, reports problems or irregularities.
Assists patients with questions on insurance claims, obtaining disability insurance benefits, home health care, medical equipment, surgical care, etc.
Processes benefit correspondence, signature, and insurance forms to expedite payment of outstanding claims.
Assists patients in completing all necessary forms to obtain hospitalization or Surgical pre-certification from insurance companies.
Follows-up with insurance companies ensuring that coverage is approved.
Posts all actions and maintains permanent record of patient accounts.
Answers patient questions and inquiries regarding their accounts.
Confirms all workers’ compensation claims with employees.
Prepares disability claims in a timely manner.
Follows-up with insurance companies ensuring that claims are paid as directed.
Maintains files with referral slips, medical authorizations, and insurance slips.
Researches all information needed to complete outpatient billing process including getting charge information from physicians.
Codes information about procedures performed and diagnosis on charge.
Keys charge information into on-line entry program.
Processes and distributes copies of billings according to clinic policies.
Assists with outpatient coding and error resolution.
Pulls charts for scheduled appointments in advance.
Delivers, transports, sorts and files returned charts.
Picks up lab reports, dictations, X-rays, and correspondence.
Continually checks for misfiled charts and refiles according to filing system.
Maintains orderly files.
Files all medical reports.
Purges obsolete records and files in storage.
Destroys outdated records following established procedures for retention and destruction.
Makes up new patient charts.
Repairs damaged charts.
Assists in locating and filing records.
Works with medical assistants and other staff to route patient charts to proper location.
Follows medical records policies and procedures.
Collects payments at time of service for daily outpatient visit services.
Reviews each account via computer to ensure patient’s account(s) are being paid on a timely basis.
Performs collection actions including contacting patients by telephone and resubmitting claims to third party reimburses.
Evaluates patient financial status and establishes budget payment plans.
Reviews accounts for possible assignment to collection agency, makes recommendation to Clinical Dept. Practice Manager.
Identifies and resolves patient billing complaints.
Participates with other staff to follow up on accounts until zero balance or turned over for collection.
Participates in educational activities.
Gathers and verifies superbills for specified practice on a daily basis.
Enters all charge and same day payment information for patient visits and hospital patients, verifying accuracy of coding, charging and patient insurance status.
Prints daily reports, verifying charge entry balancing at day end.
Backs up and closes computer files on a daily basis, logging as appropriate (i.e. closing all batches in accordance with policy).
Registers new patients after verifying patient status on computer inquiry.
Updates financial information as indicated.
Maintains strictest confidentiality.
Participates in educational activities.
Performs related work as required.
As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual.
Performs other duties as assigned.