Patient Service Representative I Job at Advocate Health Care (Byron)

Job Responsibility

Responsible for performing all job duties in a way that conforms to our customer service philosophy and consistent with our "AIDET" standards
Greet and Acknowledge all patients and family members in a welcoming and prompt manner
Introduce the patient to our services, what they can expect while under our care
Utlize appropriate etiquette in all communications
Provide the patient with information on the likely time spent in the service area (duration) including time in registration and time in clinical service
Explain the nature of our work, why we ask for demographic, socio-economic, and financial information
Explain how we safeguard their information and use it to provide better care for them
Hand-patients off to the next area with a clear "thank you"
When creating new registrations for walk-in patients, responsible for the identifying insurance coverage, the benefits available, patient out-of-pocket expenses, and collecting co-insurance and co-payments
Collecting appropriate out of pocket expenses in accordance with policy
Uses electronic systems to confirm coverage while patient is present and discussing the findings with the patient
Follow established department policies to resolve issues related to patient's eligiblity for coverage or issues in in-network status for the patient using Advocate's network
When working uninsured patients, screen for urgent status cases and follow charity procedure
Refer as appropriate for additional financial counseling
Engage leaders to resolve questions on urgent versus non-urgent/elective care
When assisting walk-in patients, screen orders for compliance with policy
Work with physicians, Care Coordinators, and clinical department leaders to communicate and resolve issues related to order quality and acceptable standards
Responsible for security authorization and precertification of inpatient and outpatient services
Notify Financial Counseling, physicians, Care Coordinators, and Utilization Management on cases were patients are found to be uninsured, or where the only insurance is Third Party Liability or Workers Compensation
Maintains knowledge of all stand-alone computer software programs to verify eligibility
Identify at risk balances related to Medicare co-days, lifetime reserve days and other Medicare coverage limits and communicate to Financial Counseling, UM and physicians
Identify at risk balances relate to Medicaid eligibility rules and communicate to Financial Counseling, UM and physicians
Initiates communication to patient when authorization is not obtained and explain the potential financial impact and the patient responsibility for unauthorized services
Accurately collects and analyzes clinical data in support of prior authorization, and precertification as required by payor guidelines
Acquires and maintains current knowledge of all insurance requirements as it relates to patient/hospital responsibility and hospital billing
Stays current of all Federal and State regulations regarding billing
Ensures completion of all established policies and procedures for identification and notification of the Primary Care Physician in the case of HMO coverage plans
Informs Financial counseling, physicians, Care Coordinators and Utilization Management of out of network or noncovered service limitations of managed care/commercial insurance where benefits are at risk
Responsible the pre-registration and registration accuracy
Maintains knowledge of State & Federal regulations governing Medicare, Medicaid and Mental Health registrations
Ensure accurate entry of patient demographic, insurance information in the ADT system with special attention to carrier code assignment, complete benefit, eligibility record and authorization data
Pre-registers and registers patients using established procedures for computer entry for all ancillary and nursing units, keeping current with their specialized needs and preparing necessary documents/records when necessary
During the pre-registration or registration encounter, provide detailed education to the patient the contents of documents and forms requiring patient signature
Manage incoming and outgoing calls in order to complete pre-registrations with patients
Generates, assembles and processes all required documents for completion of each registration
Participates in departmental team building activities and in-services and other miscellaneous duties as assigned by leader
Contributes to the quality initiatives and mission by participating in team projects
Attends all required departmental in-services to stay current of all job changes and responsibilities
Assist leader in special assignments as may be needed to fulfill the mission of the department and the organization
Performs Computerized Provider Order Entry (CPOE) for exams accurately and completely to transcribe written physician orders
Seeks clarification from technician and physician if needed
Performs light duty cleaning of changing areas as needed
Prints patient’s results CDs when required and distributes finished exam results CD to patient while complying with application HIPAA considerations
Escorts patients to changing areas as needed.

Requirements

High School Diploma with 2 years of experience in either Patient Access or any of the following related experience
general physician office support or billing office, insurance office, hospitality, or call center (any industry)
Intermediate math skills acquired through classroom work or through work experience
Typing 25 WPM
Basic understanding of web-based systems, proficiency in data entry
Ability to prioritize and organize workload
Sophisticated interviewing, communication and negotiation skills
Independent decision making
Ability to work hours that verify based on needs of the organization including evenings, weekends and holidays
Ability to work as a team member
Must be able to sit, stand, walk, lift, carry, squat, and bend frequently as well as twist, rotate, and kneel occasionally throughout the workday
Frequently lifts up to 10 lbs. and occasionally lifts between 20 lbs. or more
Must be able to push/pull up to 50 lbs. with assistance
Must have functional speech and hearing
Must be able to use hands with fine motor skills for keyboard data entry
Must be able to work a flexible schedule to support the needs of the department.

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

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