Patient Services Representative

Job Summary: Hospital outpatient services and/or department customer service representative.
Performs inpatient/outpatient/clinic/contract registration functions in accordance to hospital and department policy and quality standards.
Explains financial requirements to the patient or responsible party and collects deposits or deductibles as required.
Performs all duties related to insurance verification, insurance notification, insurance pre-authorization, patient responsibilities, patient identification in accordance with hospital and department policies.
Performs all duties related to hospital safety codes and standards in accordance with hospital and department policies.
Routinely performs job duties not related to patient registration in conjunction with other departments throughout the hospital.
Will have working knowledge of several computer applications used by hospital and department: call schedule, hospital intranet, insurance web-sites, phone system, safety systems, and others as needed.
Receives patient and community inquiries and provides accurate help.
Works closely with all Departments/areas of the Hospital to assist in providing an exceptional experience for patients, visitors and all other Healthcare providers.
Qualifications: Must have exceptional customer service skills.
Must have the ability to work closely with others, have a pleasant attitude at all times and be willing to exceed the expectations of patients, visitors, other providers and workmates.
Must be able to work and complete tasks with little supervision.
High school diploma and computer skills required.
Some education and/or experience in Medical Office or Hospital Admissions are preferred.
On the job training is provided.
Essential Functions: Specific Daily Job Duties: 1.
Open the building according to protocol.
2.
Close the building according to protocol.
3.
Verify cash box count and the beginning and end of every shift and complete daily reports & reconciliation per protocol.
4.
Prep clipboards for daily appointments per protocol.
5.
Collect co-pays and outstanding patient balances per protocol.
6.
Answer the phone 15 minutes prior to opening of clinic and until clinic closes for the day.
7.
Check voicemail prior to clinic opening, throughout the day, and prior to close.
Create patient cases and route appropriately for all health related messages.
8.
Keep front area and patient waiting room clean and organized.
Sanitize using proper protocol throughout the day and after contagious patients are seen.
9.
Keep “pick-up drawer” organized and up to date.
10.
Greet all patients, vendors, and representatives within 30 seconds upon their entry into our office.
11.
Verify identity of all visitors requesting to go past security door in waiting room and confirm that they are being escorted by staff member, have business associate agreement on file, (for vendors), have been cleared though Gritman for purposes of employment, or for purpose of volunteering or shadowing .
12.
Check-in patients – promptly register and complete check-in process in E.
H.
R.
13.
Collect/update all demographic and insurance information PRIOR to patients being taken to the clinic area (EXCEPTION: emergency situation).
14.
Verify PCP information for all Medicaid patients PRIOR to patient appointment.
Assist patient with completion of any necessary paperwork to transfer PCP and send to insurance company.
For changes that cannot be made prior to appointment, notify patient and/or get guidance from director.
(DO NOT REFUSE CARE for acute medical care needs.
) 15.
Verify Worker’s Compensation information for all work-related injuries.
Assist patients in ensuring all paperwork is completed and in order PRIOR to appointment.
16.
Scan driver’s licenses, other forms of government ID, and insurance information into HER for all patients according to protocol.
17.
Process and/or prepare all incoming and outgoing mail daily.
18.
Follow Financial Policy and financial Assistance Policy and educate patients and assist with providing financial assistance applications.
19.
Review and process clinical in-box items in a timely manner following protocol.
20.
Monitor patient waiting area for excessive wait times, potential problems, or patient inconvenience, If patients have been sitting longer than 10 minutes past heir appointment time, check with clinic staff on expected time that patient will be roomed and promptly report information to patient.
21.
Reschedule patients as needed and as requested by team lead, director, or provider.
22.
Review Call schedule and each clinic provider schedule daily so that you are aware of who is working, who is on-call, and what healthcare provider resources you have for the day.
23.
Ensure all incoming “paper” documents are scanned and routed by the end of your shift (EXCEPTION: Incoming Medical Records that are greater than 50 pages AND are not needed for an upcoming appointment can be securely stored in a locked cabinet or drawer to be worked on next shift).
24.
Check-out patients in a discreet and timely manner in the HER while also ensuring that they have all necessary information, know when they will hear from our office next, and have follow-up appointment scheduled or tickler for next appointment put in system.
25.
Ensure that all eligibility and phone issues have been fixed for the next day’s appointments.
26.
Ensure that all confirmation calls have been completed and contact made for the next day appointments.
Perform manual confirmation calls as needed.
27.
Support your co-workers and staff and back-up as needed within your legal scope of practice.
28.
Check mail/obtain at local post office if applicable.
29.
Prepare and take daily deposit to the bank.
30.
Secure all medical records, PHI, and cash prior to leaving for the day.
31.
Weekly tally of incomplete/unsigned provider encounters.
Notify director of any unsigned patient encounters beyond 5 business days.
(Provider documentation is expected to be signed off as soon as possible after the encounter.
We understand that occasional delays happen and want to also ensure that we are addressing any concerns promptly and complying with CMS expectations of complete documentation.
Medical Office Receptionist: This person must provide high quality reception support and customer service to our patients, providers, and staff, in a caring and supportive manner.
Performs opening and closing duties of office and maintains front office and waiting room throughout the day including ensuring office is free of safety hazards.
Handles telephone communications, patient check-in and check-out, processes incoming documents (both paper and electronic), labels, categorizes, and routes documents according to office procedures and protocols.
Uses office equipment such as computer, telephone, printers, facsimile, copier, scanner, label printers, coffee machine, water cooler, and other office supplies and equipment as needed.
Patient Admitting: Provides and collects appropriate paperwork and identification from patients according to clinic policies and procedures.
Performs eligibility check for all patients and resolves eligibility issues with patients and insurance.
Ensures accuracy and completeness of completed paperwork and accurately enters data and documents into the electronic medical record.
Checks patients in and out for services at the clinic and ensures follow-up services or appointment reminders are set up as needed.
Monitors waiting room and patients and assists in minimizing delays and communicating to patients and staff to resolve any concerns.
Collecting Money, Reconciling, Daily Deposit & Report: Collects co-pays as indicated by patient insurance company requirements.
Collects outstanding balances from patient and provides copy of statement and directs billing questions to clinic billing representative.
Prepares and processes daily deposit and reconciles money collected with system generated report.
Compiles daily reports and forwards to Gritman Fiscal Services department.
Immediately reports any financial discrepancies to team lead and Gritman Fiscal Services.
Medical Records: Creates new patient electronic medical records as needed, ensuring that MR# matches hospital system.
Gathers and inputs data and information to complete the medical record as needed.
Works with other healthcare providers and offices to obtain needed medical records prior to visit (i.
e.
transfer of care, ER follow-up, and other follow-up visits when outside data is needed).
Release medical records to patients or other healthcare providers as appropriate following local, state, and federal regulations and clinic policy.
EHR Clinical In-box: Processes electronic documents both incoming and outgoing through electronic fax and clinical in-box in EHR.
This includes, but is not limited to, processing and labeling incoming medical records, refill requests, consult notes, lab results, and other correspondence.
Miscellaneous: Assist overall function of office by monitoring front office area and waiting room for safety, security, privacy, and/or patient concerns.
Promptly contacts 9-1-1 for emergency situations.
Promptly notifies appropriate staff and leadership in the event of an incident or complaint AND utilizes the online reporting system and/or EHR to document as per protocol.
Relays necessary non-urgent information to team leads and/or director (i.
e.
office supplies needed, malfunction of equipment, etc.
) Organizational Expectations: Provides a positive and professional representation of the organization.
Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.
Maintains hospital standards for a clean and quiet environment.
Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.
Participates in ongoing quality improvement activities.
Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.
Complies with organizational and regulatory policies for handling confidential information.
Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in The Gritman Way.
Functional Demands Population Served: Neonatal, pediatric, adolescent, adult, and geriatric.
All genders, race, ethnicity, sociopolitical and socioeconomic demographics, marital and sexual preferences groups, developmental and physical abilities, religions, and nationalities served.
Physical Demands: Fast paced office environment that requires the ability to prioritize as the situations occur.
Some lifting (<35 lbs), reaching, pushing, pulling, twisting, bending, stooping, kneeling, up and down from computer to other equipment, typing, reading small print, reading computer screens, sitting and standing are required for this job.
Requires corrected vision and hearing to normal range, constant talking, hearing, and seeing to interact with patients, visitors, and staff Environmental Conditions: Indoors.
Exposure to limited amount of outdoor environment when sitting at Front desks.
Exposure to ice and snow during winter months when entering/exiting building and ensuring entrances are clear and de-iced for customers and visitors.
Exposure to public germs and viruses.