Patient Service Representative I

Key Responsibilities

• Creates the initial electronic health record, preventing duplicate medical records and ensuring patient safety and billing accuracy.
• Ensures compliance with organizational accrediting bodies' mandates for patient identification prior to care delivery.
• Registers patients, obtains and verifies demographic, guarantor, and insurance information.
• Discusses and collects co-pays and other patient financial responsibilities.
• Maintains patient confidentiality in accordance with HIPAA.
• Understands insurance basics, recognizes commercial and government plans, and identifies contracted plans.
• Understands and discusses financial information and obligations with patients, referring to Financial Advocates when necessary.
• Ensures compliance with government agencies and regulations such as HIPAA, EMTALA, Consent for Treatment, Patient Rights and Responsibilities, IMM, MOON, Notice of Privacy Practices, MSPQ, and ABN.
• Obtains required patient or guarantor signatures.
• May schedule patient appointments, coordinate cancellations, reschedules, wait list, and recall requests.
• Provides accurate information regarding test preparations, arrival times, medication/food/beverage guidelines, check-in procedures, and directions.
• Creates a welcoming and professional environment through extraordinary customer service.
• Greets patients and visitors, responds to information requests, and answers telephone calls, screens calls, and takes messages.
• Assists patients with transportation needs, directions, wheelchair location, and interpreter services.
• Monitors and works assigned electronic health record work queues following approved processes.
• Educates patients on insurance coverage aspects of their care.
• Interacts with physicians and their staff to resolve patient care issues.
• Collects and manages payments, including cash, and follows cash handling security procedures.

Requirements & Tech Stack

• Demonstrates Advocate Health purpose, values, and behaviors.
• Ability to work in high-profile, high-stress areas, independently setting and meeting deadlines, multitasking, and prioritizing in a fast-paced environment without direct supervision.
• Strong attention to detail and accuracy.
• Excellent customer service skills and service recovery skills.
• Demonstrated independent thinking and problem-solving skills, exercising judgment to triage issues.
• Excellent communication (written & verbal), customer service, and interpersonal skills.
• Comfort level with computer systems and demonstrated technical proficiency.
• Understanding of basic medical and insurance terms and abbreviations.
• HIPAA-compliant and knowledgeable of applicable state and federal rules/regulations.
• Ability to handle sensitive and confidential information.
• General understanding of health insurance: Medicare, Medicaid, managed care, and commercial payers.
• Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations.
• Excellent organizational skills.
• Ability to effectively act as a resource to other staff.
• Operates all necessary equipment.
• Transition from sitting to standing frequently; able to stand and sit for extended periods.
• Frequently lifts to 10 lbs. and occasionally lifts 20 lbs. or more.
• Able to push/pull up to 50 lbs. with assistance.
• Sensory requirements include vision, hearing, touch, and clear speech.
• Ability to use hands with fine motor skills for keyboard data entry.

Qualifications

• Education: High School Graduate.
• Licensure, Registration, And/Or Certification: None required.
• Preferred Experience: Experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, electronic email, Microsoft Office, Internet, and phone technology.

Physical Requirements And Working Conditions

• May require travel, exposing to weather and road conditions.
• Responds quickly to patient medical status and emergency situations in clerical areas.
• CPR certification may be required based on service location.
• Notary training/licensure may be required.
• Exposed to a normal office environment with significant patient and public contact; may be exposed to ill or contagious patients.
• May be asked to work a flexible schedule.