Patient Services Representative, Pediatrics (Floater), FT, Days

Prisma Health•Columbia, SC

12h•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 will be 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 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 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 in the patient accounting system. Signatures on all forms and documents as required will be obtained. Assistance will be provided to patients with ambulatory difficulties. The role maintains the appointment book and follows office scheduling policies, provides front office phone support as needed, and screens visitors. The representative is responsible for gathering, accurately coding, and posting outpatient charges, processing vouchers and private payments, and updating registration screens. Address verification will be researched as needed, and mail return statements and outgoing statements will be processed. Billing information for all doctors for all patients seen in practice will be acquired. Cashiering functions including monitoring and balancing the cash drawer daily, preparing daily cash deposits, and receiving payments from patients and issuing receipts will be performed. Payments will be coded and posted, and required records, reports, and files will be maintained. Patients will be worked with in securing prepayment sources or financial agreements prior to providing service. Participation with other staff to achieve account resolution, assisting with outpatient coding and error resolution, and processing edits and Customer Service and Collection Requests for resolution within specified time frames will occur. Trends will be identified and problems communicated to management. The patient account database will be updated, and current information on physician’s schedules will be maintained and updated. Surgeries, ancillary services, and follow-up outpatient appointments and admissions will be scheduled as requested. Questions regarding patient appointments and testing will be answered. Patients’ charts will be assembled for the next day’s visit, and profiles on all patients will be updated, ensuring completeness and accuracy. The waiting area will be overseen, patient movement coordinated, and problems or irregularities reported. Assistance will be provided to patients with questions on insurance claims, obtaining disability insurance benefits, home health care, medical equipment, surgical care, etc. Benefit correspondence, signatures, and insurance forms will be processed to expedite payment of outstanding claims. Patients will be assisted in completing all necessary forms to obtain hospitalization or surgical pre-certification from insurance companies. Follow-up with insurance companies will ensure coverage is approved. All actions will be posted, and a permanent record of patient accounts maintained. Patient questions and inquiries regarding their accounts will be answered. Workers’ compensation claims will be confirmed with employees, and disability claims prepared in a timely manner. Follow-up with insurance companies will ensure claims are paid as directed. Files will be maintained with referral slips, medical authorizations, and insurance slips. All information needed to complete the outpatient billing process, including getting charge information from physicians, will be researched. Information about procedures performed and diagnosis on charge will be coded. Charge information will be keyed into the on-line entry program. Copies of billings will be processed and distributed according to clinic policies. Outpatient coding and error resolution will be assisted with. Charts for scheduled appointments will be pulled in advance. Returned charts will be delivered, transported, sorted, and filed. Lab reports, dictations, X-rays, and correspondence will be picked up. Continual checks for misfiled charts will be performed and refiled according to the filing system. Orderly files will be maintained. All medical reports will be filed. Obsolete records will be purged and filed in storage. Outdated records will be destroyed following established procedures for retention and destruction. New patient charts will be made up, and damaged charts repaired. Assistance will be provided in locating and filing records. Works with medical assistants and other staff to route patient charts to proper location. Medical records policies and procedures will be followed. Payments will be collected at the time of service for daily outpatient visit services. Each account will be reviewed via computer to ensure patient’s account(s) are being paid on a timely basis. Collection actions will be performed, including contacting patients by telephone and resubmitting claims to third-party reimburses. Patient financial status will be evaluated, and budget payment plans established. Accounts will be reviewed for possible assignment to a collection agency, with recommendations made to the Clinical Dept. Practice Manager. Patient billing complaints will be identified and resolved. Participation with other staff to follow up on accounts until zero balance or turned over for collection will occur. Educational activities will be participated in. Superbills for the specified practice will be gathered and verified on a daily basis. All charge and same-day payment information for patient visits and hospital patients will be entered, verifying accuracy of coding, charging, and patient insurance status. Daily reports will be printed, verifying charge entry balancing at day end. Computer files will be backed up and closed on a daily basis, logging as appropriate (i.e., closing all batches in accordance with policy). New patients will be registered after verifying patient status on computer inquiry. Financial information will be updated as indicated. Strictest confidentiality will be maintained. Educational activities will be participated in. Related work as required will be performed. As a representative of Prisma Health Clinical Department, 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 will be performed.

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.
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.