Patient Service Representative

Overview

SCOPE : Under direct supervision, performs general business office functions that may include some or all of the following: billing and claim submissions; charge capture and payment posting; insurance verification and eligibility; obtaining pre-authorization; counseling patients and families on insurance and payment issues; and account follow-up and payment resolution. As necessary, assists patients and families with obtaining community resources including, but not limited to, housing, transportation, and financial support. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards. ESSENTIAL DUTIES AND RESPONSIBILITIES : -Ensures all insurance, demographic, and eligibility information is obtained from patients and entered into the system in an accurate and timely manner. Registers patients in the system as necessary. -Collects and reviews all patient insurance information and completes insurance forms. Collects co-pays, deductibles and other out of pocket amounts at the time of visit. -Confirms patient insurance verification and eligibility. Obtains pre-authorization of services and/or referrals. Assesses patient financial requirements and advises patients and families on insurance benefits, co-pays and financial obligations. -Posts line items and adjustments to patient accounts. Balances receipts, reconciles daily work batches and prepares audit trail. Prepares deposits for bank as needed. -Reviews Explanation of Benefits (EOB) for consistency. -Submits files and processes all claims for payment. Researches and resolves claim delay issues. -Resolves patient questions and complaints regarding insurance billing and adjusts accounts as necessary. Resubmits claims and processes all insurance/patient correspondence. Provides all documentation to expedite payment. -Follows-up on assigned accounts. Uses collection techniques to keep accounts current including monitoring for delinquent payments. -Sets-up financial arrangements with patients as necessary. -As necessary, assists patients with researching and obtaining community resources including housing, transportation, drugs and pharmaceutical supplies, and financial resources. MINIMUM QUALIFICATIONS : High School Diploma or equivalent required. This position is entry level and requires 0-3 years of medical business office experience. PHYSICAL DEMANDS : The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges. Requires vision and hearing corrected to normal ranges. WORK ENVIRONMENT : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work requires frequent interaction with patients and staff.