Patient Service Account Representative

• Greets patients and visitors and responds to routine requests for information. Answers telephone, screens calls, and takes messages.
• Registers patients; obtains demographic and insurance information; verifies insurance coverage, collects co-pays, deductibles, and previous balances at point of service; posts payments and updates demographic and insurance information.
• Schedules patient appointments and coordinates cancellations, reschedules, and additions to schedules. Provides accurate, detailed information regarding test preparations, time patient to arrive, and any other directional information needed by patient.
• Updates insurance, financial responsibility and other data when changes or additions occur, and communicates to patient as appropriate. Ensures insurance and patient information obtained is complete and accurate, applying acquired knowledge of government and third party payor requirements. Identifies, reports, and resolves problems regarding registration to appropriate individuals and departments.
• Contacts insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for patients. Follows up with physician offices, financial counselors, patients and third-party payers to complete the precertification process.
• Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
• Answers patient and guarantor questions about their statement and/or account. Utilizes system and staff to obtain information necessary to answer questions. Responds to complaints and collaborates with patient financial services as necessary.
• Arranges for payment of outstanding balances, and negotiates and establishes payment plans with patients. Provides financial options and resources available within the community. Arranges collection activities as appropriate.
• Performs visit closure including checking out patients after visit, scheduling follow-up appointments, and providing patients with a visit summary.
• Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 1 year of experience in providing customer service that includes experiences in reception, scheduling, registration, patient accounts and/or third party payer / pre-authorization requirements.

Knowledge, Skills & Abilities Required:

• Knowledge of third-party payers and pre-authorization requirements.
• Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral / precertification/ authorization processes.
• Excellent communication (written and verbal) and interpersonal skills; ability to effectively communicate with a variety of patients, staff and physicians.
• Intermediate computer skills including experience in using personal computers; including Microsoft Office or similar applications, and electronic mail.
• Excellent customer service and human relations skills.
• Strong analytical and organizational skills.
• Training or experience in keyboarding/data entry with an emphasis on speed and accuracy.
• Ability to read and understand verbal and written instructions, and to sort and file information alphabetically and numerically.
• Ability to work in a fast paced environment with a strong attention to detail and accuracy.
• Ability to work independently and manage multiple priorities effectively.

Physical Requirements and Working Conditions:

• Exposed to normal medical office environment, may be exposed to potentially ill patients.
• Must be able to sit for extended periods of time.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.