To provide customer service to patients, staff, Insurance Companies and Third Party Administrators in regards to insurance coverage issues, explanation of billing processes, payment plans and prompt payment discounts, all while maintaining a professional and calm demeanor. The Patient Services Representative will screen for CCP/MSP/AH/AEM/BCCHP prior to referral to the appropriate department for enrollment. Position Reports To:
Patient Services ManagerEssential Functions:
Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.Required:
- Daily contact with patients and account guarantors by telephone or in person in reference to account balances, explanation of billing processes, payment options (payment plan, prompt pay discount, external financing option) and financial assistance programs (CCP/MSP/AH/AEM/BCCHP).
- Maintain accurate patient account information including address and insurance information.
- Provide patients with price estimations prior to a planned upcoming procedures.
- Assist patients with their MyChart portal access.
- Thorough screening of patients and account guarantors for financial assistance programs available prior to forwarding on to appropriate department for enrollment.
- Complete comprehensive research of patient's accounts to ensure proper insurance payments and adjustments.
- Authenticate all self-pay balances on account are correct, researching possibility of enrollment in financial assistance program (CCP/MSP/AH/AEM/BCCHP).
- Work as a patient advocate and comprehensively research patient billing resolutions, while communicating progress with the patient.
- Continuous support that provides optimal function of the financial assistance programs (CCP/MSP/AH/AEM/BCCHP).
- Accurately note each account, listing the work completed and future actions to be taken, if necessary.
- Keep pace with workflow by remaining current on work and avoiding a backlog while meeting department expectations.
- Provide the patient with a yearly out of pocket expense report and/or an itemized statement for the year.
- Provide effective and professional oral and written communication with all co-workers and patients.
- Actively participate in departmental and/or organizational process improvement initiatives. (ELI)
- Follow department guidelines to assist in resolving patient billing issues, reaching out to leadership when necessary.
- Participate in process improvement and adapt to innovative concepts quickly.
- Participate in training classes, webinars and opportunities that are presented.
- Meticulously review accounts with a past due self-pay balance to ensure proper insurance payments or adjustments taken, financial assistance offered, all payment plans explored prior to submitting to collection agency.
- Process CCP applications, adjustments and correspondence as needed in a timely manner as dictated by the WAC, ACA and department policies.
- Follow established departmental policies and procedures accurately as to minimize errors.
- Actively participate in regularly scheduled productivity reviews and huddles with departmental leaders and co-workers.
- Maintain high standards of professional dress as outlined in the Confluence Health Dress Code.
- Other duties as assigned.
- High School Diploma or equivalent (GED).
- Proficient in the performance of basic math functions.
- Proficiently read, write and speak in English.
- Proficient in letter writing skills and use of effective written communication skills to convey ideas or concepts.
O = Occasional, represents 1 to 25% or up to 30 minutes in a 2 hour workday. F = Frequent, represents 26 to 50% or up to 1 hour of a 2 hour workday. C = Continuous, represents 51% to 100% or up to 2 hours of a 2 hour workday.Physical/Sensory Demands For This Position:
- Customer service experience, telephone and direct customer contact.
- Ability to communicate effectively in Spanish, verbally and in writing.
- Possesses intermediate computer skills (e.g., spreadsheets, word processing); knowledge of MS Office.
- Knowledge of ICD-10, CPT coding, medical terminology and insurance billing.
- Walking - F
- Sitting/Standing - C
- Reaching: Shoulder Height - O
- Reaching: Above shoulder height - O
- Reaching: Below shoulder height - O
- Climbing - O
- Pulling/Pushing: 25 pounds or less - O
- Pulling/Pushing: 25 pounds to 50 pounds - O
- Pulling/Pushing: Over 50 pounds - O
- Lifting: 25 pounds or less - O
- Lifting: 25 pounds to 50 pounds - O
- Lifting: Over 50 pounds - O
- Carrying: 25 pounds or less - O
- Carrying: 25 pounds to 50 pounds - O
- Carrying: Over 50 pounds - O
- Crawling/Kneeling - O
- Bending/Stooping/Crouching - O
- Twisting/Turning - O
- Repetitive Movement - F
- Normal office environment which consists of sitting at a desk for long periods of time, talking on the telephone, or working on computers and paperwork. This environment also consists of working in close proximity to co-workers and customer contact.
Physical Exposures For This Position:
- FLSA: Non-Exempt
- Hourly/Salary: Hourly
- Unprotected Heights - No
- Heat - No
- Cold - No
- Mechanical Hazards - No
- Hazardous Substances - No
- Blood Borne Pathogens Exposure Potential - No
- Lighting - No
- Noise - No
- Ionizing/Non-Ionizing Radiation - No
- Infectious Diseases - No