Patient Service Representative I

Patient Service Representative I

JOB SUMMARY: The Patient Services Representative (PSR) is responsible for completing patient registration duties including but not limited to 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.

EDUCATION/EXPERIENCE: High school diploma or GED required. Patient access (scheduling, registration and financial clearance), insurance verification, billing or certified medical assistant experience preferred.

LICENSURE, CERTIFICATION, and/or REGISTRATION: N/A

ESSENTIAL FUNCTIONS:

1. Greets patients arriving for their appointments. Monitors patient flow to ensure patients are cared for in the most efficient and courteous manner.

2. Ensures all patient demographic and insurance information is complete and accurate

3. Completes the registration process on walk-in patients, verifies and / or updates patient demographic and insurance information if changes or additions have occurred

4. 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

5. 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

6. Identifies patients in need of financial assistance and refers patients to Financial Counselor

7. Performs visit closure, including but not limited to checking out patients, scheduling follow-up appointment(s), collecting additional patient responsibility (when applicable) and providing patient with appropriate documents.

8. Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.

9. Proactively communicates issues involving customer service and process improvement opportunities to management

10. Meets productivity requirements to ensure excellent service is provided to customers

11. Meets or exceeds performance expectations of 98% accuracy rate and established department productivity measurements.

12. 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

SKILLS & QUALIFICATIONS:

• 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
• Experience with Microsoft Outlook, Word and Excel and ADT software
• 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

WORK ENVIRONMENT:

• Exposed to a normal office environment.
• Must be able to sit the majority of the workday.
• Occasionally lifts up to 10 lbs.
• Operates all equipment necessary to perform the job