Patient Service Rep I

Northern Light Eastern Maine Medical Center

Department: Ear Nose and Throat Clinic

Position is located: 925 Union Street

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:30 AM to 5:00 PM

Summary :

The Patient Service Representative I is a supporting position and is responsible for a variety of activities related to patient in-take and care. The Patient Services Representative I is generally the first point of contact for patients entering the practice. Activities may include but are not limited to greeting and checking in patients, verifying and updating insurance information and confirming other patient information, scheduling patient appointments, answering phones, updating demographic information, processing referrals, payment collection and posting, charge reconciliation, chart preparation and other duties as assigned.

Responsibilities :

• Demonstrates effective and courteous Customer, Physician/Practice Staff and other hospital staff communication skills
• Communicates in a way that conveys understanding and respect to a diverse patient and work population
• Answers all calls promptly and courteously
• Responds to and resolves issues promptly through effective communication.
• Uses appropriate chain of command
• Feedback is provided in a constructive manner
• Demonstrates problem solving skills by responding to and resolving issues promptly through effective communication skills
• Maintains adaptability in work schedule to meet patient/departmental needs
• Develops and maintains positive working relationships
• Acts as a resource to coworkers
• Confirms patient identity by using the full name
• Participates in problem solving groups as requested.
• Greeting patients, having patient(s) sign appropriate forms/consents.
• Verifying and updating demographic/insurance information on all encounter forms and systems per protocol. Notifying registration of changes if applicable.
• Demonstrating mastery of appropriate practice software and registration tool protocols.
• Scheduling tests, procedures, referral appointments with scheduling center, agencies and/or other provider groups and forwarding order form and/or records to appropriate depart/office. Documenting information in Patient's chart. Processing insurance referral/prior authorization and document this per protocol.
• Retrieving and processing messages per protocol.
• Assists with orientating and training/cross-training of new and established employees as assigned.
• Provides coverage in other areas as needed
• Effectively covers other support positions (e.g. phones, insurance referrals, scheduler) as needed
• Demonstrates mastery of appropriate scheduling and registration protocols, if appropriate
• Takes ownership for determining customers’ needs and offering assistance
• Schedules outpatient testing per orders/referral process, inputs appointment dates and times into patient EMR, if appropriate
• Recognizes problems and offers constructive solutions
• Performs other duties as assigned by practice leadership
• Reviews material submitted by Health Plans and Managed Care Organizations to gain full understanding of benefit coverage and precertification/authorization, if appropriate
• Quality review procedures are followed to ensure accounts are brought to a timely and accurate resolution, if appropriate
• Ability to prioritize and perform multiple duties, simultaneously
• Ability to take ownership of work and follow up on responsibilities
• Speaks, spells, and writes clearly, concisely and to the point
• Consistently follows Patient Identification IDD by using two patient identifiers related to the registration process
• Patient Identification Manager will be alerted if duplication medical record numbers are identified
• Proper name format is consistently followed
• Managed care organizations are correctly identified and selected as part of the registration process, if appropriate
• Timely modifications of registrations are done in order to ensure billing of encounters, if appropriate
• Uses independent judgment when necessary
• Assists Office Manager with patient complaints related to billing invoices, if appropriate
• Appropriately refers patients/staff with issues/concerns to the direct supervisor
• Performs Service Recovery when necessary
• Has 100% of iCare, employee updates and any other in-services meetings and training as assigned
• Maintains documented evidence of continuing education
• Insurance verification and precertification is performed prior to elective inpatient admission to ensure accounts are secured upon admission, if appropriate
• Names, dates, and times of conversations with businesses, insurances, managed care organizations, Utilization Review, and patients are documented, if appropriate
• Insurance verification and precertification is performed on high dollar outpatient areas to ensure reimbursement, if appropriate
• Understands the implication both clinically and financially of registration errors and the impact on the organization, if appropriate
• Referral calls are made to PCP for Managed Care patients, if appropriate
• Correct insurance is identified and selected when appropriate within the registration fields, if appropriate
• Policy numbers are entered correctly into the registration fields, if appropriate
• Ensures that referral authorization numbers are submitted to Patient Account Services in a timely manner and understands the implications if this is not done, if appropriate
• Finishes work on time 95% of the time, avoiding overtime.
• Prepares billing sheets and codes invoices prior to sending to Accounts Payable, if appropriate
• Collects payments (cash, co-payments, cash, checks and other forms of payment for services rendered; reconciles cash drawer/journal per organization policy; promptly secures/delivers the cash deposits in the designated organization safe or other designated area for transit to the Fiscal Services Department, if appropriate
• Oversees daily audit/cash control, if appropriate
• Promotes services at Northern Light Health
• Meets continuing education requirements set forth by the practice
• Seeks opportunities for enhancement of skills
• Assists with answering questions and directing practice staff to appropriate resources
• Attends 100% of employee updates.

Other Information :

Competencies and Skills

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

• Required High School Diploma/General Educational Development (GED)

Working Conditions