Patient Service Representative

About the Role

Incumbents are responsible for aspects of Physician Practice front office management and operation as assigned. May be responsible for some or all front office functions.

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.
• Greets patients and visitors promptly, courteously, and helpfully.
• 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 a 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 check information.
• 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 the 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 the next day’s visit.
• Updates profiles on all patients, ensuring completeness and accuracy.
• Oversees the 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 the outpatient billing process, including getting charge information from physicians.
• Codes information about procedures performed and diagnoses on charges.
• Keys charge information into an 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 the 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 locations.
• 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 reimburses.
• Evaluates patient financial status and establishes budget payment plans.
• Reviews accounts for possible assignment to a collection agency and makes recommendations to the Clinical Department 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.
• Registers new patients after verifying patient status on computer inquiry.
• Updates financial information as indicated.
• Maintains strictest confidentiality.
• Performs related work as required.

Requirements & Tech Stack

• High School Diploma or equivalent
• Public contact
• Excellent interpersonal skills
• Computer reports
• Appointment book
• Patient accounting system
• On-line entry program
• Computer inquiry

Qualifications

• No Previous Experience Required
• Associate's Degree in a technical specialty program of 18 months minimum in length - Preferred
• Multi-specialty group practice setting experience - Preferred
• *Basic understanding of ICD-9 and CPT coding - Preferred

Work Shift: Day

Location: NE Columbia Medical Park