Patient Service Representative Lead – Specialty Clinics

• Oversees the daily activities of the patient service area to ensure department standards are met. Educates staff of any changes pertinent to their roles. Orders supplies according to budget guidelines and department needs.
• Identifies staffing needs and communicates those needs to leadership. Ensures all personnel department policies and procedures are followed. Assists with new caregiver onboarding.
• Maintains patient flow to ensure patients are cared for in the most efficient and courteous manner. Resolves patient concerns.
• Completes the registration process on walk-in patients, verifies and/or updates patient demographic and insurance information if changes or additions have occurred. Schedules patient visits using guidelines established within scheduling system.
• Verifies insurance benefits, obtains/calculates patient responsibility and request payment. Communicates to patient the organization expectation of payment at time of service.
• Identifies patients in need of financial assistance and refers patients to Financial Advocate when necessary. Collaborates with Financial Advocate to coordinate patient’s financial resources and responsibilities including requesting patient to sign a Financial Obligation Form (FOF) or Advanced Beneficiary Notice (ABN) as needed.
• Performs visit closure, including checking out patients, scheduling follow-up appointment(s), collecting additional patient responsibility (when applicable) and providing patient with appropriate documents.
• Monitors and works assigned EPIC work queues, following the department’s work flow process.
• Maintains excellent public relations with patients, families, and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information. Proactively communicates issues involving customer service and process improvement opportunities to management.
• 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.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 5 years of experience in a physician office, patient access or outpatient surgical center environment.

Knowledge, Skills & Abilities Required:

• Demonstrated 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/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
• Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre-certification/authorization processes.
• Excellent interpersonal skills required in order to communicate effectively with patients, regardless of age, physicians and other hospital staff members, exercising a high degree of tact and poise.
• Analytical skills including the ability to facilitate data collection, communicate policies and procedures, interpret and relate federal and state regulatory changes.
• Demonstrated ability to lead a team by motivating and facilitating staff professional growth and development.
• Ability 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 and flexibility.
• Knowledge of continuous quality improvement and customer focus methods and processes.

Physical Requirements and Working Conditions:

• Sits, stands, walks, bends, twists and reaches above shoulder the majority of the work day or sits approximately 90% of the workday depending upon location.
• Frequently lifts up to 10 lbs. and occasionally lifts between 20 lbs. or more. This occurs when moving equipment and supplies and when transporting patients and/or charts.
• Sensory requirements include vision, hearing and touch.
• Exposed to a normal office environment with significant patient and public contact.
• 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.