Patient Services Representative, Orthopedics-Patewood, FT, Days

Prisma Health•Greenville, SC

2d•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. It also includes posting all payments, balancing computer reports at day end, and requires a high level of public contact and excellent interpersonal skills. The position arranges for patient pre-payments and enforces financial agreements prior to providing service. It involves gathering charge information, coding, entering into a 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, greets patients and visitors courteously, checks in patients, verifies and updates insurance information, and obtains necessary signatures. The role also involves maintaining the appointment book, providing front office phone support, screening visitors, and responding to routine information requests. Additional duties include gathering, coding, and posting outpatient charges, processing payments, researching address verification, handling returned and outgoing statements, acquiring billing information, performing cashiering functions, preparing daily cash deposits, and working with patients on prepayment sources or financial agreements. The representative will participate in account resolution, assist with outpatient coding and error resolution, process edits and customer service requests, identify trends, update patient account databases, maintain physician schedules, schedule appointments and admissions, answer patient questions, assemble patient charts, update patient profiles, oversee the waiting area, and assist patients with insurance and benefit-related questions. The role also involves processing benefit correspondence, signature, and insurance forms, assisting with pre-certification, following up with insurance companies, posting actions, maintaining patient account records, answering account inquiries, confirming workers’ compensation claims, preparing disability claims, and following up on claim payments. The representative will maintain files, research information for billing, code procedures and diagnoses, key charge information, process and distribute billings, pull and file charts, pick up reports and correspondence, check for misfiled charts, maintain orderly files, file medical reports, purge obsolete records, destroy outdated records, make new charts, repair damaged charts, assist in locating and filing records, and work with other staff to route charts. The role also includes collecting payments at time of service, reviewing accounts for timely payment, performing collection actions, evaluating patient financial status, establishing payment plans, reviewing accounts for collection agency assignment, resolving billing complaints, and participating in educational activities. The representative will gather and verify superbills, enter charge and payment information, print and verify daily reports, back up and close computer files, register new patients, update financial information, and maintain strict confidentiality. As a representative of Prisma Health Clinical Department, the individual is expected to maintain a neat and professional appearance, demonstrate commitment to serve, and uphold office guidelines. Performs other duties as assigned.

Requirements

High school diploma or equivalent OR Post-high school diploma.
No previous experience required.
Basic understanding of ICD-9 and CPT coding preferred.
Current Prisma Health team members with 1 year of Prisma Health experience in this job profile will be accepted (in lieu of education requirements).

Nice To Haves

Associate degree in technical specialty program of 18 months minimum in length preferred.
Multi-specialty group practice setting experience preferred.

Responsibilities

Complete and accurate patient registration, pre-certification, charge capture, and accurately coding diagnoses given by physicians.
Posting all payments and balancing with the computer reports at day end.
Arranging for patient pre-payments and enforcing financial agreements prior to providing service.
Gathering charge information, coding, entering into database, completing billing process, distributing billing information.
Filing insurance claims and assisting patients in completing insurance forms.
Processing unpaid accounts by contacting patients and third-party payers.
Greeting patients and visitors in a prompt, courteous, and helpful manner.
Checking in patients, verifying and updating necessary insurance information in the patient accounting system.
Obtaining signatures on all forms and documents as required.
Assisting patients with ambulatory difficulties.
Maintaining appointment book and following office scheduling policies.
Providing front office phone support as needed and outlined through cross training program.
Screening visitors and responding to routine requests for information.
Gathering, accurately coding and posting outpatient charges.
Processing vouchers and private payments, to include updating registration screens based on information on checks.
Researching address verification as needed.
Helping to process mail return statements and outgoing statements.
Acquiring billing information for all doctors for all patients seen in practice.
Performing cashiering functions including monitoring and balancing cash drawer daily.
Preparing daily cash deposits.
Receiving payments from patients and issuing receipts.
Coding and posting payments and maintaining required records, reports and files.
Working with patients in securing prepayment sources or financial agreements prior to providing service.
Participating with other staff to achieve account resolution.
Assisting with outpatient coding and error resolution.
Processing edits and Customer Service and Collection Request for resolution within specified time frames.
Identifying trends and communicating problems to management.
Updating patient account database.
Maintaining and updating current information on physician’s schedules.
Scheduling surgeries, ancillary services and follow-up outpatient appointments and admissions as requested.
Answering questions regarding patient appointments and testing.
Assembling patients’ charts for next day visit.
Updating profiles on all patients, ensuring completeness and accuracy.
Overseeing waiting area, coordinating patient movement, reporting problems or irregularities.
Assisting patients with questions on insurance claims, obtaining disability insurance benefits, home health care, medical equipment, surgical care, etc.
Processing benefit correspondence, signature, and insurance forms to expedite payment of outstanding claims.
Assisting patients in completing all necessary forms to obtain hospitalization or Surgical pre-certification from insurance companies.
Following-up with insurance companies ensuring that coverage is approved.
Posting all actions and maintaining permanent record of patient accounts.
Answering patient questions and inquiries regarding their accounts.
Confirming all workers’ compensation claims with employees.
Preparing disability claims in a timely manner.
Following-up with insurance companies ensuring that claims are paid as directed.
Maintaining files with referral slips, medical authorizations, and insurance slips.
Researching all information needed to complete outpatient billing process including getting charge information from physicians.
Coding information about procedures performed and diagnosis on charge.
Keying charge information into on-line entry program.
Processing and distributing copies of billings according to clinic policies.
Assisting with outpatient coding and error resolution.
Pulling charts for scheduled appointments in advance.
Delivering, transporting, sorting and filing returned charts.
Picking up lab reports, dictations, X-rays, and correspondence.
Continually checking for misfiled charts and refiling according to filing system.
Maintaining orderly files.
Filing all medical reports.
Purging obsolete records and files in storage.
Destroying outdated records following established procedures for retention and destruction.
Making up new patient charts.
Repairing damaged charts.
Assisting in locating and filing records.
Working with medical assistants and other staff to route patient charts to proper location.
Following medical records policies and procedures.
Collecting payments at time of service for daily outpatient visit services.
Reviewing each account via computer to ensure patient’s account(s) are being paid on a timely basis.
Performing collection actions including contacting patients by telephone and resubmitting claims to third party reimburses.
Evaluating patient financial status and establishing budget payment plans.
Reviewing accounts for possible assignment to collection agency, makes recommendation to Clinical Dept. Practice Manager.
Identifying and resolving patient billing complaints.
Participating with other staff to follow up on accounts until zero balance or turned over for collection.
Participating in educational activities.
Gathering and verifying superbills for specified practice on a daily basis.
Entering all charge and same day payment information for patient visits and hospital patients, verifying accuracy of coding, charging and patient insurance status.
Printing daily reports, verifying charge entry balancing at day end.
Backing up and closing computer files on a daily basis, logging as appropriate (i.e. closing all batches in accordance with policy).
Registering new patients after verifying patient status on computer inquiry.
Updating financial information as indicated.
Maintaining strictest confidentiality.
Performing related work as required.
Maintaining neat and professional appearance, demonstrating commitment to serve at all times and upholding guidelines set forth in office manual.
Performing other duties as assigned.