Patient Services Representative

About the Role

Responsible for aspects of front office management and operation as assigned.

Key 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 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, and distributes billing information.
• Files insurance claims and assists patients in completing insurance forms.
• Processes unpaid accounts by contacting patients and third-party payers.
• Acts as a 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, including updating registration screens based on information on checks.
• Researches 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 Requests for resolution within specified time frames.
• Identifies 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 visits.
• Updates profiles on all patients, ensuring completeness and accuracy.
• Oversees waiting area, coordinates patient movement, and 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, signatures, 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 a 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 the proper location.
• Follows medical records policies and procedures.
• Collects payments at the 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 reimbursers.
• Evaluates patient financial status and establishes budget payment plans.
• Reviews accounts for possible assignment to a collection agency, makes recommendations to the 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 the 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 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.
• Performs other duties as assigned.

Requirements & Tech Stack

• Basic understanding of ICD-9 and CPT coding preferred.
• High school diploma or equivalent OR Post-high school diploma.
• Associate degree in a technical specialty program of 18 months minimum in length preferred.
• In lieu of education requirements, current Prisma Health team members with 1 year of Prisma Health experience in this job profile will be accepted.

Qualifications

• High level of public contact and excellent interpersonal skills.