Patient Service Representative - Gastro

The Patient Service Representative - Operations is responsible for discussing insurance coverage, including usual and customary charges, Medicare and Medical Assistance availability, reimbursement options available for services, educating patients regarding the Clinic's billing and credit policies, work with patient's insurance carrier to verify benefits coverage for treatment, and discuss any credit concerns regarding a past due account and make special arrangements if necessary to assure payment will be made in a timely manner.

Job Relationships

Reports to the Operations Manager or Director of the service line

Principal Responsibilities

• Verify / secure referrals.
• Verify coverage and benefits prior to treatment.
• Secure prior-approval and pre-authorizations.
• Perform review and action of Bad Debt, Collections, and Denials.
• Maintain proficiency with insurance and billing issues and serve as a resource to providers and staff.
• Prepare account action worksheets and submit to Patient Accounting for charge corrections.
• Provide a positive impression to patients about the Clinic's billing department.
• Enter / edit patient insurance coverage / demographic information when necessary.
• Inform patients of the Clinic's billing and credit policies.
• Answer questions that patients may have in regard to insurance coverage and other billing issues.
• Respond to patient's verbal and written requests in a timely fashion.
• Maintain statistics.
• Maintain proficiency with insurance and billing issues by participating in Patient Accounting meetings and training sessions as appropriate.
• Must be empathetic, yet responsive to patients while adhering to Patient Accounting billing practices and guidelines.
• Provide coverage at other Springfield Clinic locations as assigned.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education / Experience

Knowledge, Skills and Abilities

Working Environment

PHI / Privacy Level

HIPAA1