Patient Service Representative I AHWFB

About the Role

The Patient Services Representative (PSR) is responsible for completing patient registration duties including collecting and validating accurate patient demographic and insurance information, obtaining pre-certification or authorization as required, and entering all necessary information into Wake Forest Baptist Medical Center (WFBMC) ADT system. The PSR is responsible for informing the patient of their estimated liability, collecting patient liabilities, identifying patients in need of financial assistance, and referring patients to financial counseling as necessary. This position requires multi-tasking and effective problem-solving skills. It is expected that the PSR will foster positive relationships with all patients in an effort to provide quality service.

Key Responsibilities

• Greets patients arriving for their appointments. Monitors patient flow to ensure patients are cared for in the most efficient and courteous manner.
• Ensures all patient demographic and insurance information is complete and accurate.
• Completes the registration process on walk-in patients, verifies and / or updates patient demographic and insurance information if changes or additions have occurred.
• Verifies insurance benefits. Obtains, calculates, and collects the patient’s out-of-pocket financial liability. Requests and collects past due and present balances or estimates due.
• Follows the Financial Clearance policy for non-urgent patient services if financial clearance has not been completed or authorization has not been obtained, when appropriate.
• Identifies patients in need of financial assistance and refers patients to Financial Counselor.
• Performs visit closure, including checking out patients, scheduling follow-up appointment(s), collecting additional patient responsibility (when applicable), and providing the patient with appropriate documents.
• Maintains knowledge of and reference materials for: Medicare, Medicaid, and third-party payer requirements, guidelines, and policies; insurance plans requiring pre-authorization/referral; and a list of current accepted insurance plans.
• Proactively communicates issues involving customer service and process improvement opportunities to management.
• Meets productivity requirements to ensure excellent service is provided to customers.
• Meets or exceeds performance expectations of 98% accuracy rate and established department productivity measurements.
• Maintains excellent public relations with patients, families, and clinical staff, and demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information.

Requirements & Tech Stack

• Microsoft Outlook, Word, and Excel
• ADT software

Qualifications

• High school diploma or GED required.
• Ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available.
• Knowledge and ability to articulate explanations of Medicare, HIPAA, and EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
• Mathematical aptitude, effective oral and written communication skills, and critical thinking skills.
• Understanding of basic human anatomy, medical terminology, and procedures for application in the patient referral, pre-certification, and authorization processes.
• Ability to speak effectively to customers or employees of the organization; presents a pleasant, professional demeanor and image during telephone conversation.
• Ability to handle sensitive and confidential information according to internal policies.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine correspondence, calculate figures and amounts such as discounts and percentages.
• Must be able to work with minimal supervision, to problem-solve in a high-profile and high-stress area, and interact positively with all internal and external customers while possessing the ability to determine priority of work.
• Patient access (scheduling, registration and financial clearance), insurance verification, billing or certified medical assistant experience preferred.