Patient Services Representative, Patewood Outpatient Center, FT, Days

Prisma Health•Greenville, SC

7d•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 with 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 role also includes filing insurance claims, assisting patients with insurance forms, and processing unpaid accounts by contacting patients and third-party payers. The Patient Services Representative 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. They assist patients with ambulatory difficulties, maintain the appointment book, and follow office scheduling policies. Phone support and screening visitors are also part of the duties. The role is responsible for gathering, accurately coding, and posting outpatient charges, processing payments, and performing cashiering functions including balancing the cash drawer and preparing daily deposits. They work with patients on prepayment sources or financial agreements and participate with other staff to achieve account resolution. The position assists with outpatient coding and error resolution, processes edits and customer service requests, identifies trends, and communicates problems to management. Updating patient account databases and physician schedules, scheduling appointments, answering patient questions, and assembling patient charts are key responsibilities. The role also involves assisting patients with various insurance and benefit-related questions, processing benefit correspondence, and following up with insurance companies for pre-certification and claim approval. They post actions, maintain records of patient accounts, answer account inquiries, confirm workers’ compensation claims, and prepare disability claims. The representative researches information for outpatient billing, codes procedures and diagnoses, keys charge information, and distributes billings. They pull and file charts, transport records, pick up medical reports, and maintain orderly files. Obsolete records are purged and outdated records are destroyed according to procedures. New patient charts are created, damaged charts are repaired, and assistance is provided in locating and filing records. The role works with medical assistants and other staff to route charts and follows medical records policies. Collections include reviewing accounts, contacting patients, resubmitting claims, evaluating financial status, establishing payment plans, and recommending accounts for collection agencies. Identifying and resolving billing complaints and following up on accounts until zero balance are also duties. The representative participates in educational activities, gathers and verifies superbills, enters charge and payment information, prints and verifies daily reports, and backs up computer files. New patients are registered, financial information is updated, and strict confidentiality is maintained. As a representative of Prisma Health Clinical Department, a neat and professional appearance, commitment to serve, and adherence to office manual guidelines are expected. Performs related work as required and 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, and 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, making 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.
Participating in educational activities.
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.