What are the responsibilities and job description for the Patient Services Representative position at Wake Forest?
JOB SUMMARY:
Oversees processing of professional and hospital charges and the patient account from the time the charges are posted until the time all insurance balances are paid or all efforts for collecting monies from insurance companies have been exhausted. Responsible for coordinating reports to assure receipt of accurate payment for services. Follows reports for accurate insurance reimbursement, follows up with insurance companies for coding corrections, and additional payment. Responds to all patient inquiries and answers any questions pertaining to their insurance.
EDUCATION/EXPERIENCE:
High school diploma or GED equivalent with two years' experience with third-party reimbursement.
One year of medical coding experience.
ESSENTIAL FUNCTIONS:
1. Reviews, edits, and assists CFS with re-filing insurance claims as needed. Maintains CPT, ICD-9, and HCPCS coding knowledge.
2. May post hospital charges. Follows up with hospital to assure all needed information has been obtained to accurately file claims.
3. Consults with insurance providers to verify benefits.
4. Acts as liaison between patient and Cornerstone Financial Services.
5. Creates a financial agreement for patients with pending and current Cornerstone balances and obtains a signed Budget Payment Agreement. Provides counseling to patients with delinquent accounts, with no insurance or resources to make payments.
6. Responsible for accurate documentation and follow-through of all patient contacts and patient complaints.
7. Assists CFS with tracking and follow-up of unpaid claims through insurance carriers, challenging insurance carriers when inappropriate benefits have been paid.
8. Follow each insurance carriers guidelines for the appeals process to expedite turnaround.
9. Assists CFS with reviewing reimbursement from third party payers to ensure payment through proper use of codes.
10. Works with new and established patients checking insurance coverage and any available patient assistance.
11. Works with office manager and physicians to resolve coding issues in their departments.
12. Actively participates as a team member by supporting decisions, accepting change, managing conflict effectively and valuing the contributions of others.
13. May fill-in for other support staff when necessary. May serve as backup for Collector/Data Entry personnel during absences and backup for weekend dictation/hospital list.
14. Effectively and efficiently communicates on the telephone and in person with patients and colleagues in a courteous manner. Assists with referral problems and updates insurance information.
SKILLS/QUALIFICATIONS:
Knowledge of CPT, ICD-9, HCPCS coding policies and procedures Knowledge of reimbursement practices including third-party reimbursement Knowledge of organizational policies, procedures and protocols Knowledge of common safety hazards and universal precautions to establish a safe work environment Knowledge of English grammar, punctuation, and spelling Knowledge of computer systems and applications
WORK ENVIRONMENT:
Clean, well-lit, comfortable, office environment Moderate noise level
