Description
At NorthBay Health, the Patient Services Representative performs general front office duties of moderate scope and complexity including reception, registration, appointment scheduling, insurance verification and medical records management functions. The Patient Services Representative II exercises judgment within defined guidelines and functions as part of a clerical and customer service team in support of Ambulatory Division medical practices.
PRIMARY JOB DUTIES: Performs independently all of Level 1, in addition but not limited to the following:
Registration and Charge Entry
Gathers, updates and verifies a comprehensive package of registration and insurance/payer information and ensures accurate entry into the EMR.
Provides information to patients regarding the selection process of a care provider, assists in determining insurance eligibility, co-payments, share of costs and other financial responsibilities for services rendered. Obtains signatures on required forms.
Verifies and documents eligibility for all payers at the time of service.
Reviews benefit plan/s with patient to determine specific allowances and/or restrictions based on services requested.
Researches and answers inquiries related to claims, eligibility and referrals.
Collects co-payments, deposits and fees, reconciling all payments at the end of their shift.
Ensures the accuracy of demographic and insurance information in accordance with the policies, procedures and service expectations of each department.
Maintains professional standards by actively participating in committees, in services and QI activities and standards development.
Acts as a resource to new and existing staff in areas of subject matter expertise.
Presents a professional demeanor in appearance and attitude.
Serves as a job expert in assigned areas.
Provides orientation to new staff as assigned.
Floats to other areas, as requested.
Performs other duties, as assigned.
Appointment Scheduling and Reception:
Obtains complete demographic information for new patients ensuring accurate entry into the EMR. Confirms and accurately updates demographic information for existing patients.
May confirm eligibility and PCP assignment status (Primary Care) for patients prior to scheduling appointment.
Demonstrates effective listening and problem-solving skills to determine appropriate call routing.
Schedules appointments on the phone or in person in accordance with approved protocols and current scheduling policies, procedures and algorithms
Assists with referral coordination/scheduling (Specialty Care).
Monitors provider schedules to ensure appointments are booked for correct type and correct time allocation.
Proactively manages provider schedules for optimal patient access and no-show reduction.
Places confirmation or rescheduling calls in accordance with scripted guidelines and current policy and procedures.
Assists in physician schedule maintenance functions including coordination of physician absences with open appointment times.
Gathers data for provider access audits; provide appointment access for KPI's.
Greets and welcomes patients and assists them with initial questions regarding appointments, payments, schedules, etc.
Medical Records
Adheres to System policies related confidentiality of medical record information, transcription and copies or distribution of medical record content.
Handles patient documents appropriately to ensure patient confidentiality. Includes handling of medical records outside designated storage area.
Demonstrates understanding of PHI management and HIPAA compliance by successful completion of annual competency validation.
Qualifications
Education:
Some college business or computer course work preferred.
Course work in medical terminology preferred.
Licensure/Certification:
Current AHA or equivalent BLS certification required.
Experience / Skills:
Two years of customer engagement experience and/or service centered role required.
Experience within a healthcare environment in medical record processes, appointment scheduling, referral and authorization processes, registration process, and back office clinical support preferred.
Excellent customer service skills required.
Excellent oral and written communication skills with ability to effectively articulate thoughts into a productive and meaningful discussion.
Ability to successfully manage multiple priorities effectively and within expected timeframes.
Working knowledge in the areas listed below, required:
Differentiation of the unique characteristics of the following insurance types: Medi-Cal, Medicare, Managed Care, Indemnity and Workers Compensation.
Impact of completeness and accuracy the registration/admission process on successful claims processing and receipt of payment.
Impact of completeness and accuracy the registration process on the delivery of safe, high quality patient care.
Organizational process and procedures
NorthBay Health's Clinical computer systems
Demonstrated service excellence including, but not limited to professionalism, customer focus, compassion, strong listening skills and a warm demeanor.
Consistently exhibits empathy, optimism, resourcefulness and cultural competency in interactions with others.
Open to learning new things and partnering with others in a collaborative environment.
Proven track record of conducting him/herself in a manner that demonstrates an understanding of the unique complexities and challenges of the healthcare environment.
Strong organizational skills.
Hours: Based on business need.
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