Patient Service Representative

Reports to the Manager or Director. Is responsible for the coordination of services for patients at the assigned clinic or site, which includes: admitting and discharging patients, contacting third-party payers for authorization/documentation/pre-certification, copying patient records and billing and scheduling new patients. Duties may also include performing a variety of routine secretarial duties, (i.e., preparing a variety of statistical or special reports, greeting customers, answering the telephone, filing, etc.).MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

• Admitting and discharging patients, which includes discharging from computer system, completing chart audit form, discharging the patient chart and making the bar code label.
• Communicating, verbally and in writing, with third-party payers in order to ensure appropriate verification of services and payment.
• Scheduling new patients.
• Copying patient records and billing when appropriate for insurance companies, attorneys, subpoenas, patients, Vocational Rehabilitation and Disability Determination Board.
• Preparing, as needed, a variety of statistical reports and associated documentation required by grant guidelines and third-party regulatory bodies, per the Director or Manager.
• Performing a variety of routine secretarial duties (i.e., typing, computer, greeting customers, answering the telephone, filing, etc.).
• Supporting the Director and Manager in the completion of special reports and/or department documentation and utilizing the Hospital computer system to run routine client service and demographic reports.

• Interviewing patients via telephone for pre-admission or upon presentation for admission in the registration area.
• Obtaining identification, demographic, physician and insurance information from patients and accurately entering this information into the Hospital financial system.
• Updating the system after validation of the new patient's financial information.
• Explaining about the possible need to pre-certify with the patient's insurance carrier in order to ensure maximum coverage to the limits of the insured's insurance policy.
• Verifying and documenting insurance coverage via online eligibility systems, internet resources or via telephone.
• Requesting copies of the insurance card(s) and drivers license or other government picture ID to confirm insurance benefits and identification.
• Validating medical necessity via the MCA Compliance Checker where applicable.
• Completing the MSP (Medicare Secondary Payor) questionnaire by asking the patient the questions based on pt availability.
• Requesting payment either during the pre-registration process, when the patient presents for service or at Patient Check Out in ECC in accordance with MHSB's policies and procedures.
• Referring the patient to the Financial Counselors or Eligibility Specialists if they are unable to secure satisfactory payment arrangements and have a self-pay balance of $500 or more. Also assisting in obtaining additional patient information, copies of insurance card(s) and church information.
• Obtaining all required signatures for the "consent to treat" and assignment of insurance benefits forms.
• Obtaining pre-certification information from the insurance company's pre-certification unit (i.e., whether pre-certification is required, if the ordering physician has completed it, etc.).
• When the ordering physician has not completed the pre-certification, calling the physician's office to initiate the pre-certification process and following up until it has been completed.
• When the ordering physician has completed the pre-certification, documenting the authorization and releasing the account.

• Assisting the department to meet or exceed its quality assurance goals.
• Striving to accurately process an optimal number of registrations (or pre-registrations) during one's shift.
• Maintaining records, reports and files as required by departmental policies and procedures.
• Performing time of service collections effectively by achieving assigned collections goals and maintaining strong patient relations.

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

• The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent); additional college-level business courses are preferred. Two to three years of progressively responsible experience in a related healthcare services environment is required.

• Requires a thorough knowledge of general office policies and procedures, secretarial functions and rehabilitation Patient Services.
• Demonstrates the ability to operate and effectively utilize a multiple line telephone system and the Hospital information system.
• Demonstrates well-developed communication skills, both verbal and written, needed to effectively interact with clients, staff and third-party payers (both internal and external).
• Demonstrates knowledge of and a commitment to Beacon Health System's mission and values; and the organization's goal of providing exceptional patient experiences by following the Performance Essentials.
• Requires basic office and keyboarding skills (with the ability to type a minimum of 40 wpm) and the ability to use designated reference materials and office equipment (i.e., computer, printer, fax machine, calculator, etc.).
• Requires effective telephone skills (for example, to accurately take and relay information about patients, physician orders and referrals).
• Demonstrates proficient computer skills (i.e., data entry, word processing and spreadsheets). Requires the ability to use multiple databases (such as Pathways Healthcare Scheduling, RelayHealth, Cerner and PCA Compliance Checker).
• Requires a complete understanding of time of service collections. Specifically, must understand why it is necessary and must be able to effectively communicate this to MHSB's patient community as necessary.
• Requires basic knowledge of medical terminology, private insurance coverage (and managed care).
• Demonstrates the interpersonal skills necessary to interact effectively with patients from various backgrounds in a professional, enthusiastic, courteous, friendly, caring and sincere manner. Also demonstrates the ability to maintain effective working relationships with other departments, physicians and their office staff.
• Demonstrates the verbal communication skills needed to communicate in a clear and effective manner when conducting patient interviews, answering patients' questions and communicating with other departments and physician offices.
• Good listening skills are required. Sensitivity to individuals who do not speak English as their first language is expected.

• Must be able to be effective in a busy, dynamic and fast-paced office environment.

• Requires the physical ability and stamina to perform the essential functions of the position.