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Position Description:
The Patient Service Representative (PSR) is a clinical operations care team member reporting to the Office Manager and/or Front Desk Supervisor. The position is responsible for providing the full scope of a) inbound and outbound access patient interactions & functions whether by telephone, Internet or face: face, b) patient scheduling & logistics, c) executing daily workflows including cancellation, missed visit and tickler-recall deployment and d) executing revenue cycle claim scrubbing & missing slip completion. The Patient Services Representative (PSR) acts as a liaison between referral sources, clinical services team, physicians and patients for assistance with any needs related to care delivery and office & surgical visits. The Patient Services Representative works independently to ensure that services are coordinated in a timely, accurate and courteous manner by effectively addressing patient or care team member concerns expeditiously while using discretion to determine when to involve the Office Manager and/or Front Desk Supervisor.
ROLE AND RESPONSIBILITIES
Executes patient scheduling for optimum patient experience while maintaining office efficiency, whether by inbound/outbound telephone contact, internet-online booking applications-or in person.
Executes all necessary patient access check-in/check-out workflows to facilitate positive impressions with proactive attention in order to meet or exceed expectations, address concerns and optimize experience with exceptional customer service and professionalism as standard.
Execute and accurately complete full registration for patients requesting appointments adhering to policies and procedures regarding appointment scheduling and registration processes, performing these tasks accurately with attention to detail to ensure the highest quality standards.
Execute workflows to effectively manage scheduling of cancellations, missed visits, recalls and tickler deployment daily & timely.
Verify insurance information, benefits and insurance referral information by performing eligibility and benefits.
Obtain legal photo identification and (if applicable) insurance card (s), and validate patient identity and coverage (if applicable) prior to services being rendered thereby ensuring patient safety and financial reimbursement.
Provide immediate service recovery by taking ownership of any problems that may arise and resolving them utilizing appropriate rationale and understanding of when to alert and involve Office Manager or Front Desk Supervisor.
Provide patients with and interpret patient rights and responsibilities.
Interact with patients and collaborate with providers and clinicians to appropriately schedule appointments considering scheduling guidelines per division/specialty/provider, resource availability, special needs, timeframes, medical necessity, and payer and contractual guidelines.
Determine appointment type and utilize analytical skills to determine appropriate slot utilization and instances when overbooking is appropriate.
Maintain a working knowledge of medical symptoms, signs, and anatomical systems to identify and differentiate type and urgency of medical need.
Obtain and/or verify that all demographic, financial, and insurance coverage information is accurate, up to date and complete, and that financial clearance has been obtained inclusive of all required referrals/authorizations. Obtain and document pertinent insurance verification information (ie CPT codes, service description, reason for visit, etc.) needed to obtain referral/authorization/pre-cert in order to avoid denials and ensure financial reimbursement.
Provide patient/guarantor with detailed benefit and authorization requirements and co-pay, deductible, and co-insurance self-pay responsibility.
Explain charges, fees, and previous balances for both technical and professional components.
Reconcile all collections and transactions at the end of each shift including initial cash funds. Appropriately secure all day end monies in designated locked box.
Determine upon checkout/discharge any pending financial responsibility and collect and post payment(s) accordingly.
Comply with all standard operating procedures established to support key metrics and quality assurance initiatives that contribute toward prompt billing and increased cash flow.
Identify systematic warning flags/messages and populate required data elements in order to eliminate by- passed warnings/errors and avoid a negative impact on downstream revenue cycle processes.
Monitor and clear patient work queues on a daily basis to ensure data integrity, prompt billing and minimal AR days.
Enter charge codes and number of units accurately and within (1) business day of services being rendered.
Perform daily reconciliation to identify missing charges and follow up with providers to obtain in order to ensure all rendered services are accounted for and billed.
Review DAR and identify appointments that are not in completed status
Properly open and close the facility to ensure the office is clean and organized for our patients and staff.
Ensure that phones are forwarded to answering service and appropriate information – physician on – call coverage has been communicated.
POSITION QUALIFICATIONS
Education & Experience: High School Graduate or General Education Degree (GED) experience in patient facing healthcare function or hospitality customer service function.
KNOWLEDGE/SKILLS/ABILITIES
Working knowledge of medical symptoms, signs, and anatomical systems to identify and differentiate type and urgency of medical need.
Knowledge of insurance referral requirements to ensure access based on third party reimbursement criteria.
Excellent verbal and written communications skills in English. Bi-Lingual (English/Spanish, English/Polish, English/French, English/Arabic) a plus.
Must possess excellent, critical thinking, analytical, troubleshooting, problem resolution, and customer service skills.
Excellent mathematical and cash management skills.
Excellent interpersonal skills and ability to work effectively with physicians, co-workers, other departments and patients of all ages, and from across a broad range of cultural and social economic backgrounds.
Ability to work as an integral team member under minimal supervision, in a fast-paced, complex environment.
Ability to show tolerance and sensitivity in stressful situations and safeguard confidential information in accordance with established policies and HIPAA regulations.
Computer literate and ability to use multiple systems and acquire proficiency in multiple electronic systems
Computer Skills
Proficient with Microsoft Office Suite
WORK ENVIRONMENT
An office environment with controlled atmosphere. Possible exposure to staff or patients with communicable diseases and blood borne pathogens.