Patient Services Representative III

Description

The following statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. 

A. Position Summary

Although there are many priorities within this position, the number one objective is to ensure that all claims coming out of your site locations will end up paid or with a very low percentage of denied claims. You will be a primary source of verifying if the PSR’s at your site are completing the registration process and verification correctly resulting in payable encounters, you will report the findings to your HCM with regularity. Under the close supervision of the Health Center Manager, in coordination with Dental Central Billing this position is required to be proficient an all PSR II competencies. Including but not limited to greeting patients and visitors entering the health center, registers new and returning patients, collects payments from patients for their visit, places self-pay patients on payment plans, reviews all insurance benefits to include frequency limitations, deductible, co-insurances, wait periods and all other details involved in the dental insurance realm, review of next appointments and the ability to articulate these details to the patient in laymen’s terms, with ease. The ability to comprehend dental coding, payments, adjustment’s and read the Dentrix ledger with ease and confidence. The ability to manage an AR (self-pay and Insurance) for a minimum of 90 days to ensure NO claims go “timely” at your site. The knowledge and understanding of every dollar on the AR and the status of that money for your site, you will be responsible to answer to those accounts at any given time and keep regular documentation on the status of the claim without fail, the knowledge to assist a patient with account questions and the ability to know when you need to consult our Dental Central Billing Team. Preparing the daily deposit and preparing the daily batch for Dental Central Billing in a timely manner every day. ALL conducted in a manner that is supportive and responsive to patients and visitors, in addition to all PSR III duties this position also requires. A PSRII will “cover” this position when the PSR III is away. Position requires a level of Dental Billing experience that will require you to communicate to our DCB Dept., Providers and most importantly the patient so that all have a good understanding of their bill, the process and the end result of their account. 

B. Primary and Essential Duties/ Responsibilities  

Patient Reception/Patient Registration/ Dental Billing

1. Greets new and returning patients and clients entering the health center and checks them in for scheduled and walk-in appointments.
2. Updates patient records to verify contact information.
3. Greets other visitors to the health center and directs them to the appropriate offices or individual staff.    
4. Provides general information to patients concerning functions of FCCH.
5. Answers the telephone and connects callers to the appropriate offices or individual staff.
6. Schedules new office appointments and return appointments over the telephone and in person.    
7. Pulls and files dental charts when necessary.
8. Other duties as assigned.
9. Proficient in all dental billing practices.

Patient Registration:      

1. Meets with patients to collect required personal, health, and insurance information for the permanent patient record.
2. Enters accurate patient data into the computer system daily.
3. Collect patients’ copay/coinsurance/deductible/deposit at time of service.
4. Keeps accurate, balanced, locked cash bad/box and is personally responsible for any imbalance in the daily reconciliation of cash receipts.
5. Verifies insurance eligibility for Medicaid, Medicare, and third-party payors.
6. Verifies personal income according to established guidelines for all patients.
7. Follows appropriate computer downtime procedures.
8. Scans patient registration documents as directed.
9. Merges duplicate patient files in PWPM, if assigned.
10. Verifies in detail all dental benefits to include frequency limitations, deductibles, wait periods, percentages of coverages per procedure. 

Patient Billing:

1. Answers telephone billing inquiries and resolves problems in a timely manner. 
2. Demonstrates ability to maintain daily record of all billing receipts and prepares the bank deposit and cash reconciliation report for the Finance department. 
3. Assists the Health Center Manager with collection calls and letters.
4. Works closely with Dental Central Billing office in all aspects of billing/collections.
5. Responsible for maintaining a 90-day AR (Insurance and Self Pay), to ensure that no claim “goes timely” at the site and no patient balance is ignored. 
6. Consistently follows the checkout guidelines when checking a patient out after a dental appt. to include, but no limited to- check the document center to ensure we have collected what we need to be paid for the encounter, check to make sure a procedure has been charged by a provider, check to make sure diagnoses codes are in the system, check for any outstanding claims (past) and bring those to the attention of Dental Central Billing, check for an outstanding balance and make sure we have an active payment plan if necessary, collect the payment, check to make sure the next appt. is fully approved, and payable by the insurance company and if it is not make the proper arrangements for the upcoming appointment.
7. Will with regularity attend billing meetings with the Dental Operations Manager and Dental Central Billing Manager.
8. Will stay in close communication with the Dental Central Billing Team, when needed.
9. Ability to research a claim to get claim status, when needed.
10. Ability to recognize when referral assistance is needed and the ability to recognize the need for a DPCF referral.
11. Will track your site errors and conduct meetings with PSRI’s and II’s at your site when needed. 
12. Upon request by the HCM this position will be required the auditing some pt. statements prior to them being sent.
13. Other duties as assigned.

Requirements

C. MINIMUM EDUCATION AND EXPERIENCE

1. High School graduate or GED certificate  
2. Two years of onsite dental billing experience.
3. Bi-lingual English/Spanish is preferred.   
4. Must possess all PSR II knowledge.  
5. Must possess the ability to accurately understand dental benefit knowledge and the ability to articulate them to patient in layman’s terms, with ease.

D. LICENSES/CERTIFICATIONS REQUIRED

1. None

E. KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

1. Knowledge of patient registration/ billing/ collections, procedures, and documentation.
2. Receptionist skills. 
3. Knowledge of applicable FCCH patient-related forms and programs.
4. Ability to interact and communicate with people over the telephone, often in stressful situations. 
5. Knowledge of planning and scheduling techniques. 
6. Knowledge of pre-certification requirements, procedures and documentation of third-party medical insurance payors or other patient healthcare funding programs.
7. Ability to analyze and solve problems. 
8. Skill in the use of personal computers and related software applications. 
9. Appropriate knowledge and familiarity with various compliance programs and elements. Cooperates fully and complies with applicable laws and regulations. 
10. Ability to maintain quality, safety, and/or infection control standards
11. Basic knowledge of general office procedures to include filing, copying, and faxing.  
12. Ability to use a multi-line telephone to schedule appointments.
13. Ability to use a computer to enter patient data and retrieve information to generate reports and payment receipts. 
14. Ability to work on multiple tasks within established deadlines.
15. Ability to work under the direction of a supervisor and follow instructions for work completion.   
16. Ability to take the initiative to resolve patient concerns and problems.  
17. Able to work well with diverse groups of people.
18. HIPAA Educated.

F. Age of Patients Served

1. all ages.

G. Physical Characteristics/Working Conditions

A person in this position has sufficient time to complete most tasks although under pressure depending on patient and organization demands. There are frequent opportunities to relax from any physical exertion or to change position in work activities.

1. Physical Effort and Dexterity: Good dexterity to operate personal computer and office equipment. Occasional lifting and carrying related to office duties. 
2. Machines, Tools, Equipment required to be operated: Capable of using office machines and personal computers for word processing, data entry and spreadsheet applications.    
3. Visual Acuity, Hearing, and Speaking: Must be able to read a computer monitor and outputs accurately. Must be able to communicate clearly and accurately for work and safety compliance.
4. Environment/Working Conditions: Work is mostly inside an office in a controlled environment. Normal office safety precautions and practices are required. Position requires travel throughout the Albuquerque metropolitan area. Work regularly scheduled Monday-Friday, although weekends may be required to meet deadlines.