What are the responsibilities and job description for the Patient Financial Services Representative – Diagnostic Services position at Cancer Care Specialists of Illinois?
SUMMARY: Under the general supervision of the Patient Financial Services Supervisor, the Patient Financial Services Representative is responsible for patient chart review to ensure medical necessity, completes pre-authorizations, and assists patient in answering questions regarding billing and financial assistance.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Business Office Duties
- Completes prior authorizations for diagnostic procedures. Is knowledgeable of the insurance carrier’s policies and works with them on the phone, internet, and paper submissions to obtain the pre-authorizations.
- Utilizes the telephone and payor and third party websites to verify patient’s insurance coverage and benefits prior to the and during treatment as required.
- Utilizes the telephone and payor and third party websites to obtain prior authorizations or predeterminations of coverage for Bone Marrow Biopsies, BRCA & BART, CT, PET Scans, Echo, PFT, Sleep Studies, Tissue Biopsies procedures and flow cytometry as requested.
- Explains billing policies/procedures, insurance benefits, and financial responsibility to patients.
- Identifies the location of services suitable for under insured patients considering financial assistance available to the patient and other providers.
- Researches payor medical policies to ensure medical necessity is met as required by the patient’s medical insurance.
- Responds to patient inquiries (on-site visits and per phone), including researching relevant information, contacting payors on behalf of patients, and informing patients of the outcome.
- Serves as a resource person for physicians, staff and patients/family/significant others regarding insurance and billing issues and questions.
- Is proficient in EPIC system to perform all functions of the job.
- Maintains a working knowledge of CPT-4 and ICD-10 CM coding systems, governmental regulations, protocols and third party requirements, as well as compliance issues, related to billing and billing documentation.
- Professional Communication
- Maintains confidentiality in matters relating to all aspects of employment, including patient/family/significant other confidentiality.
- Interacts with patients/family/significant others with a variety of developmental and sociocultural backgrounds.
- Maintains professional relationships and conveys relevant information to other members of the health care team.
- Internal Contacts: Providers, nursing staff, laboratory staff, pharmacy staff, office staff, other Business Office staff, etc., and staff at other CCSI facilities.
- External Contacts: Insurance representatives, coding specialists, hospitals, other physician offices, hospice staff, etc.
- Relays information appropriately over telephones, facsimiles, e-mail, and other communication methods, and follows-through as needed.
- Communicates appropriate information to physicians, supervisors, and/or other members of the healthcare team as needed, and follows-through on physician orders and requests.
- Teamwork
- Works collaboratively as a health care team member.
- Assists with tasks necessary for the general operation and organization of the Business Office.
- Maintains positive attitude with patients, family/significant others and coworkers.
- Professional Development
- Attends staff meetings and mandatory in-services.
- Participates in continuing education opportunities.
- Contributes to the quality of patient services and participates in quality improvement initiatives.
OTHER DUTIES:
- Complies with all applicable safety and health regulations, policies and procedures. Complies with established personal protective equipment requirements necessary for protection against exposure to blood and body fluids, other potentially infectious material, chemical disinfectants, and other hazardous substances.
- Performs other duties as assigned.
EDUCATION/QUALIFICATIONS: High school graduate or equivalent. Previous experience in a medical office or hospital registration, scheduling or prior authorization preferred. Medical terminology required. Must take EPIC training and successfully pass required tests.
KNOWLEDGE/SKILLS/ABILITIES: Knowledge of medical terminology, anatomy and physiology, clinical medicine, diagnostic tests, radiology, pathology, pharmacology, and other medical specialties related to medical oncology/hematology. Knowledge of CPT-4 and ICD-10 CM coding systems, governmental regulations, protocols and third party requirements, as well as compliance issues related to billing and billing documentation. General knowledge of basic manual and computerized Lab / Practice Management / EMR systems. Verbal and written English communication skills. Eye, hand, and auditory coordination. Basic computer skills. Problem solving and prioritization skills. Ability to work independently with minimal supervision and as part of a team; ability to work under pressure with time constraints; ability to meet deadlines and work with frequent interruptions; ability to concentrate, provide close attention to detail, and handle multiple tasks simultaneously. Ability to maintain professional attitude at all times; ability to handle telephone and face-to-face contact with patients, physicians and other staff. Ability to function in a sometimes demanding and fast-paced work environment related to changing patient needs, including work with patients with acute, chronic, and complex disease processes and those who are dying. Understands and practices patient confidentiality. A positive attitude towards health care team members and diverse patient populations.
PHYSICAL REQUIREMENTS OF JOB: Standing, walking, sitting, carrying, pushing, pulling, lifting, bending, stooping, squatting, crouching, twisting, reaching, handling, kneeling, and wrist and digital dexterity. Involves significant degree of data entry. Involves significant degree of sitting, and involves standing or walking for brief periods of time. Speaking, hearing, and visual acuity to communicate with patients, physicians and other health care professionals; use telephone system; and operate office equipment and computers. Exerting force (frequently up to 10 pounds and occasionally up to 20 pounds or more) to lift, carry, push, pull or otherwise move objects, including office supplies, medical charts, billing forms, etc. Limited driving.
MENTAL DEMANDS: Must be able to work under stress and adapt to changing conditions. Must be able to concentrate and focus on details.
WORKING CONDITIONS: Normal medical office environment. Job duties involve minimal potential for exposure to blood and body fluids, chemical disinfectants, and limited exposure to chemicals such as cleaning disinfectants and toners for office equipment.
