Patient Services Representative, Ambulatory Internal Resource Pool, FT, Days

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose:  Inspire health.  Serve with compassion.  Be the difference.

• Responsible for complete and accurate patient registration, precertification, charge capture and accurately coding diagnoses given by physicians.  Responsible for posting all payments and balancing with the computer reports at day end.  Arranges for patient pre-payments and enforces financial agreements prior to providing service.  Gathers charge information, codes, enters into database, completes billing process, distributes billing information.  Files insurance claims and assists patients in completing insurance forms.  Processes unpaid accounts by contacting patients and third-party payers.

• Serves as a liaison between patient and medical support staff.

• Greets patients and visitors in a prompt, courteous, and helpful manner.

• Checks in patients, verifies and updates necessary insurance information in the patient accounting system (online registration).

• Obtains signatures on all forms and documents.

• Assists patients with ambulatory difficulties.

• Maintains appointment book and follows office scheduling policies.

• Provides front office phone support as needed and outlined through cross training program.

• Responsible for gathering, accurately coding and posting outpatient charges to superbills.

• Processes vouchers and private payments, to include updating registration screens based on information on checks.

• Helps to process mail return statements and outgoing statements.

• Performs cashiering functions including monitoring and balancing cash drawer daily. Prepares daily cash payments

• Receives payments from patients and issues receipts. Codes and posts payments and maintains required records, reports and files.

• Processes edits and Customer Service and Collection Request for resolution within specified time frames.

• Maintains and updates current information on physician’s schedules.

• Schedules surgeries, ancillary services and follow-up outpatient appointments and admissions

• Oversees waiting area, coordinates patient movement, reports problems or irregularities.    

• Research all information needed to complete outpatient billing process including getting charge information from physicians.

• Codes information about procedures performed and diagnosis on charge.

• Keys charge information into on-line entry program.

• Processes and distributes copies of billings according to clinic policies.

• Delivers, transports, sorts and files returned charts.

• Picks up lab reports, dictations, X-rays, and correspondence.

• Files all medical reports.  Purges obsolete records and files in storage.

• Destroys outdated records following established procedures for retention and destruction.

• Makes up new patient charts.  Repairs damaged charts.  Assists in locating and filing records.

• Works with medical assistants and other staff to route patient charts to proper location.   

• Assist patients with questions on insurance claims, obtaining disability insurance benefits, home health care, medical equipment, surgical care, etc.

• Processes benefit correspondence, signature, and insurance forms to expedite payment of outstanding claims.

• Assists patients in completing all necessary forms to obtain hospitalization or Surgical pre-certification from insurance companies.

• Follows-up with insurance companies ensuring that coverage is approved.

• Posts all actions and maintains permanent record of patient accounts.

• Answers patient questions and inquiries regarding their accounts

• Confirms all workers’ compensation claims with employees.

• Prepares disability claims in a timely manner.

• Maintains files with referral slips, medical authorizations, and insurance slips.   

• Collects payments at time of service for daily outpatient visit services.

• Performs collection actions including contacting patients by telephone and resubmitting claims to third party reimburses.

• Evaluates patient financial status and establishes budget payment plans.

• Reviews accounts for possible assignment to collection agency and makes recommendations

• Participates with other staff to follow up on accounts until zero balance or turned over for collection. 

• Enters all charge and same day payment information for patient visits and hospital patients, verifying accuracy of coding, charging and patient insurance status.

• Backs up and closes computer files on a daily basis, logging as appropriate (i.e. closing all batches in accordance with policy). 

• Registers new patients after verifying patient status on computer inquiry. Updates financial information as indicated.

• Maintains strictest confidentiality.

• Participates in educational activities.

• Performs other duties as assigned.