REPRESENTATIVE PATIENT SERVICES- CASUAL

Job Summary/Overall Objectives

Responsible for coordinating and maintaining a positive customer experience while performing pre-registration, registrations, scheduling and business office functions.  Registers patients for the department. Contacts Physician’s office to obtain necessary information to obtain an insurance authorization. Contact patient to schedule and ask screening question prior to testing. Call insurances companies for authorization for testing.

Essential Job Functions

• Customer Focus. Assesses customers' needs and considers customer in all decision-making processes to ensure a positive customer experience.
  • Greets the customer in a polite and professional manner whether face-to-face or on the phone, determines needs and responds appropriately and courteously.
  • Responds to customer issues (intra-departmental, inter-departmental, and public) timely and to the satisfaction of the customer.
  • Identifies and performs appropriate action in situations where it is necessary to obtain appropriate documentation for proper advancement through the revenue cycle.
  • Provides instructions and guidance for new patients to assure smooth services.
• Provides constructive feedback and clearly expresses ideas.
  • Interviews patients and/or their representatives to obtain accurate demographic, insurance, and claim adjudication information in a timely, courteous, professional manner.
  • Updates system appropriately and accurately, ensuring appropriate signatures are obtained and required authorizations/certifications/medical necessity guidelines are met.
  • Communicates with management all issues that impact the accurate, timely and complete accomplishment of all assigned tasks.
  • Identifies and communicates to management recommendations for process improvement.
• Readily accepts and incorporates changes into daily activities.
  • Conform consistently to all system changes, including insurance payer regulations.
  • Possess functional knowledge of systems and the revenue cycle to adequately assist customers and reduce the unnecessary transfer of workflows, where applicable by department.
• Motivation and influencing. Influences and persuades others to build commitment to quality and a positive hospital experience.
  • Acts as a role model for peers by striving for excellence, displaying a positive attitude, and actively supporting the team concept.
  • Monitors and reports on individual productivity to assist in the evaluation of one's ability to organize and plan daily work to meet outcome-based criteria set by management.
• Fiscal Accountability. Hold self-accountable for departmental processes to obtain maximum reimbursement for services and the successful flow of the revenue cycle.
  • Assures proper identification of patients presenting for services following the proper departmental procedures.
  • Maintains accuracy of insurance coverage and guidelines including not but limited to verifying coverage through online eligibility software/insurance websites/customer service phone lines; completing Medicare Secondary Questionnaire when required; verifying medical necessity and ABN processes; determining, if necessary, authorizations or referrals have been obtained; ensuring each order meets current published standards; etc.
  • Investigates and identifies patient-responsibility dollar amounts to successfully collect point-of-service payments when appropriate.
• Charge posting where applicable when staff is not available timely.
• Follows all specific department processes and policies as required and updated; including department procedures for position responsibilities.
• Makes all appointment reminder calls daily.
• Other duties as assigned.

Competency and Experience [Knowledge, Skills and Abilities]

Required Qualifications/Experience

• High School Diploma, GED or higher level of education.
• Experience in patient registration or related training, preferably within the past five (5) years.
• Strong leadership ability, good organizational skills, independent and critical thinking skills, sound judgment, and knowledge of legal aspects and liability of nursing practice.
• Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.

• Medical Terminology and knowledge of Payor/Insurance Benefits.
• Keyboard proficiency, proficient spelling skills and knowledge of basic Office Equipment such as copier, fax machine, etc.

Preferred Qualifications/Experience

• Registration experience in healthcare setting.

License, Certification & Clearances

• Act 34-PA Criminal Record Check from the PA State Police system

Position Type/Expected Hours of Work

• Incumbent will be scheduled based on operational need (rotate shifts, standby, on-call, etc.).
• Travel may be expected locally between System locations.

Equal Employment Opportunity

Independence Health and its affiliated companies are Equal Opportunity Employers. It is their policy to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, disability, veteran status, or genetic information, or any other classification protected by law. Independence Health and its affiliated companies will comply with all applicable laws and regulations.

Disclaimer

This job description is not designed to contain a comprehensive listing of all activities, duties or responsibilities that are required of the employee. Moreover, duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Work Environment  Effective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines

Physical Demands

When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.