Patient Services Representative, Pediatric Adolescent Medicine, FT

Prisma Health•Greenville, SC

11d•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. Responsibilities include gathering charge information, coding, entering into the database, completing the billing process, and distributing billing information. The role also involves filing insurance claims, assisting patients with insurance forms, and processing unpaid accounts by contacting patients and third-party payers. This position acts 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. Assistance is provided to patients with ambulatory difficulties, and the appointment book is maintained according to office scheduling policies. Front office phone support is provided as needed through a cross-training program. Visitors are screened, and routine requests for information are handled. The role is responsible for gathering, accurately coding, and posting outpatient charges, processing vouchers and private payments, and updating registration screens. Address verification is performed as needed, and mail return statements and outgoing statements are processed. Billing information for all doctors for all patients seen in practice is acquired. Cashiering functions are performed, including monitoring and balancing the cash drawer daily, preparing daily cash deposits, and receiving payments from patients with issued receipts. Payments are coded and posted, and required records, reports, and files are maintained. Patients are worked with in securing prepayment sources or financial agreements prior to service. Account resolution is achieved with other staff. Outpatient coding and error resolution are assisted with. Edits and Customer Service and Collection Requests are processed within specified time frames. Trends are identified, and problems are communicated to management. The patient account database is updated, and current information on physician’s schedules is maintained and updated. Surgeries, ancillary services, and follow-up outpatient appointments and admissions are scheduled as requested. Questions regarding patient appointments and testing are answered. Patients’ charts are assembled for the next day’s visit. Profiles on all patients are updated, ensuring completeness and accuracy. The waiting area is overseen, patient movement is coordinated, and problems or irregularities are reported. Patients are assisted with questions on insurance claims, obtaining disability insurance benefits, home health care, medical equipment, surgical care, etc. Benefit correspondence, signatures, and insurance forms are processed to expedite payment of outstanding claims. Patients are assisted in completing necessary forms for hospitalization or surgical pre-certification from insurance companies. Follow-up with insurance companies is conducted to ensure coverage approval. All actions are posted, and a permanent record of patient accounts is maintained. Patient questions and inquiries regarding their accounts are answered. Workers’ compensation claims are confirmed with employees. Disability claims are prepared in a timely manner. Follow-up with insurance companies is conducted to ensure claims are paid as directed. Files are maintained with referral slips, medical authorizations, and insurance slips. All information needed to complete the outpatient billing process, including obtaining charge information from physicians, is researched. Information about procedures performed and diagnosis on charge is coded. Charge information is keyed into an on-line entry program. Billings are processed and distributed according to clinic policies. Outpatient coding and error resolution are assisted with. Charts for scheduled appointments are pulled in advance. Returned charts are delivered, transported, sorted, and filed. Lab reports, dictations, X-rays, and correspondence are picked up. Misfiled charts are continually checked and refiled according to the filing system. Files are maintained in an orderly manner. All medical reports are filed. Obsolete records are purged and filed in storage. Outdated records are destroyed following established procedures for retention and destruction. New patient charts are made up, and damaged charts are repaired. Assistance is provided in locating and filing records. Works with medical assistants and other staff to route patient charts to the proper location. Medical records policies and procedures are followed. Payments are collected at the time of service for daily outpatient visit services. Each account is reviewed via computer to ensure patient’s account(s) are being paid on a timely basis. Collection actions are performed, including contacting patients by telephone and resubmitting claims to third-party reimburses. Patient financial status is evaluated, and budget payment plans are established. Accounts are reviewed for possible assignment to a collection agency, and recommendations are made to the Clinical Dept. Practice Manager. Patient billing complaints are identified and resolved. Participation with other staff occurs to follow up on accounts until zero balance or turned over for collection. Educational activities are participated in. Superbills for the specified practice are gathered and verified on a daily basis. All charge and same-day payment information for patient visits and hospital patients is entered, verifying the accuracy of coding, charging, and patient insurance status. Daily reports are printed, verifying charge entry balancing at day end. Computer files are backed up and closed on a daily basis, logging as appropriate (i.e., closing all batches in accordance with policy). New patients are registered after verifying patient status on computer inquiry. Financial information is updated as indicated. Strict confidentiality is maintained. Educational activities are participated in. Related work is performed as required. As a representative of Prisma Health Clinical Department, the individual is expected to maintain a neat and professional appearance, demonstrate commitment to serve at all times, and uphold guidelines set forth in the office manual. 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.

Nice To Haves

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

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.
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.
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.
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.