Patient Service Representative - Outpatient Eligibility / Procedural Authorization

Patient Service Representative - Outpatient Eligibility / Procedural Authorization

Responsible for accurate and complete patient accounts based on departmental protocol, policies and procedures, and compliance with regulatory agencies, to include but not limited to pre-admission, admission, pre-registration and registration functions. Ensure all insurance requirements are met prior to patients' arrival, and inform patients of their financial liability. Arranges payment options with the patients and screens patients for government funding sources. This position has high customer service with our payors and physicians by phone and requires excellent customer service skills. This position is very similar to the Financial Care Counselor. This position completes all preliminary work. The Financial Counselor completes the work when the patient arrives.

Analyze insurance coverage and benefits for service to ensure timely reimbursement. Obtain all PAC and / or authorizations as appropriate. Facilitate referral to Financial Services for payment sources for uninsured patients. Determine if patient's condition is the result of an accident, performing complete research to determine the appropriate source of liability / payment. Schedules and pre-register patients, correcting as necessary all patient demographic and financial data. Resolve insurance claim rejections / denials and remedy expediently. Call patients to remind them to bring balances due, co-pays, co insurance and deductible. Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy. Perform those duties necessary to ensure all accounts are processed accurately and efficiently. Promote and maintain excellence in customer service. Explain billing to patients according to PRMO credit and collection policies, when discussing insurance with patients. Implement appropriate collection actions and assist financially responsible persons in arranging payment. Make referral to Financial Services Representative for counseling. Determine necessity of third party sponsorship and process patients per policy and procedure. Examine insurance policies and other third party sponsorship materials for sources of payment. Inform attending physician of patient financial hardship. Update the billing system to reflect the insurance status of the patient. Provides timely and effective customer service to internal customers. Assist with departmental coverage as requested. Obtain authorizations based on insurance plan contracts / guidelines, document in billing system per policy and procedure. Enter and update referrals as required. Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment for specific patients and benefits.

Excellent communication skills, oral and written. Ability to analyze data, perform multiple tasks and work independently. Must be able to develop and maintain professional, service-oriented working relationships with patients, physicians, co-workers and supervisors. Must be able to understand and comply with policies and procedures.

Education : Work requires knowledge of basic grammar and mathematical principles normally required through a high school education, with some postsecondary education preferred. Additional training or working knowledge of related business.

Experience : Two to five years experience working in hospital access, physician office or billing and collections or an equivalent combination of relevant education and / or experience.

Degrees, Licensures, Certifications : None required.