Patient Services Representative F/T Day

Prisma Health•Simpsonville, SC

1d•Onsite

About The Position

The Patient Services Representative is responsible for various aspects of front office management and operation within Prisma Health. This role involves comprehensive patient registration, pre-certification, accurate charge capture, and coding of diagnoses. The representative will handle financial agreements, process billing information, file insurance claims, and manage unpaid accounts, serving as a crucial liaison between patients and medical support staff. Key duties include greeting patients, verifying insurance details, maintaining appointment schedules, providing phone support, and managing patient accounts and records. The position also encompasses cashiering functions, collection actions, evaluating patient financial status, and resolving billing complaints. Adherence to Prisma Health's purpose to "Inspire health. Serve with compassion. Be the difference." and maintaining a professional appearance are essential.

Requirements

High school diploma or equivalent OR Post-high school diploma
No previous experience required
High level of public contact and excellent interpersonal skills

Nice To Haves

Associate degree in technical specialty program of 18 months minimum in length
Multi-specialty group practice setting experience
Basic understanding of ICD-9 and CPT coding

Responsibilities

Responsible for aspects of front office management and operation as assigned
Be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
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
Liaison between patient and medical support staff
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
Maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual