Patient Relations Rep V

The primary purpose of the Wilson County Department of Public Health is to improve health, prevent disease, protect against exposure to environmental hazards, and promote health equity for all.

Independently evaluate and collect proof of income from individual patients to determine eligibility in relation to sliding fee scale. Communicate clearly with patients to assure patients’ full comprehension of fees, rules, and rights.  Enter encounter in electronic health record to determine the charge of the visit. Collect payment in cash check or credit card from patient and apply to the account, giving the patient a receipt of payment, if balance is left unpaid instruct patient of policy on unpaid balances.  If necessary, facilitate a payment agreement to assist the patient with uncomplicated options of payment. Communicate with insurance companies by calling to inquire essential information, such as verification of benefits, and effective dates of eligibility. Receive and post payments from insurance companies and complete write-offs according to the insurance EOB.  When posting EOBs for insurance, work denials to make sure account is correct.

Bill patients for co-payments, and deductible.  Call patients back when they leave messages and discuss patient’s inquiries about our billing system. Explain procedures of how our sliding fee scale works.   Accept payments over the phone when a patient wants to use their credit/debit card.   

Works denials on the outstanding balance report.  Complete a daily batch out for the day’s payment collection and deposit report.

Once a patient’s visit is complete, the Patient Relations Representative V is responsible for reviewing the encounter for accuracy and completeness and entering that information into the Electronic Health Record (EHR) in order to either bill the patient or the insurance company.   Encounters are entered daily to ensure timely submission and billing to Medicaid, Medicare and commercial insurance companies.  Incomplete or incorrectly coded encounters are tasked back to the provider to be corrected.  Once claims are submitted, the PRR is responsible for working and resubmitting any denied claims and making sure that payments are posted correctly.  Provide feedback to Supervisor and request assistance when there are billing issues that are not resolved.

Collect co-payments for insured customers and fees from customers without insurance.  Fee charges are determined by utilizing a sliding fee scale provided by the state and are based on the size and income of the family.  Payments are taken and applied to the appropriate account in the electronic health record.  At the end of the day, payments collected are counted and balanced with the day’s batch report out of the electronic health record.  All of which are turned in to the supervisor who generates a deposit slip.

Data Entry: 

Ensure patient demographics are updated as patients come into the clinic.  Ensure proper information is entered into the Electronic Health Record (EHR) for maintenance of records, reports, and statistical data.  The Patient Relations Representative then records and bills all components using the ICD-10 and CPT codes provided electronically by clinic nurses.   Review encounters for accuracy and reconcile with EHR.

Other Duties:    

1. Call, email, or fax referrals as ordered by the Mid-level provider
2. Ensure a superbill is received and signed by the Mid-level provider for each client served
3. Make copies of forms for clients
4. Scan outside lab results or other correspondence as needed into Electronic Health Record (EHR)
5. Prepare any letters or correspondence needed to assist RN clinic coordinator and or the Mid-Level provider
6. Prescriptions:   Type and print prescription labels periodically.
7. Review Electronic Health Record before clinic appointments.  Check for insurance coverage, outstanding balances, or patients needing financial updates before being seen in a clinic.
8. Provide LabCorp confirmation spreadsheet of patients with/without insurance to give to the finance manager.
9. Review death certificate report for patients in electronic health record and North Carolina Immunization Registry and update accordingly.
10. Main contact for Primary Care and Immunization billing and insurance issues – work with clerical staff assigned to these programs and the Primary Care and Immunization Program Coordinators.

Graduation from high school and demonstrated possession of knowledges, skills and abilities gained through at least three years of office assistant/secretarial experience; or completion of a two-year secretarial science or business administration program with one year of responsible experience as described above; or an equivalent combination of training and experience.  

Salary : $37,788 - $63,876