Northern Light Eastern Maine Medical Center

Department: Primary Care - Pediatric

Position is located: Northern Light Pediatric Health Center

Work Type: PRN

Hours Per Week: Variable

Work Schedule: Variable

Summary:

The Patient Service Representative I is a supporting position and is responsible for a variety of activities related to patient in-take and care. The Patient Services Representative I is generally the first point of contact for patients entering the practice. Activities may include but are not limited to greeting and checking in patients, verifying and updating insurance information and confirming other patient information, scheduling patient appointments, answering phones, updating demographic information, processing referrals, payment collection and posting, charge reconciliation, chart preparation and other duties as assigned.

Responsibilities:

Communicates effectively

Demonstrates effective and courteous customer, physician/practice staff and other hospital staff communication skills

Communicates in a way that conveys understanding and respect to a diverse patient and work population

Answers all calls promptly and courteously

Responds to and resolves issues promptly through effective communication.

Uses appropriate chain of command

Feedback is provided in a constructive manner

Demonstrates problem solving skills by responding to and resolving issues promptly through effective communication skills

Maintains adaptability in work schedule to meet patient/departmental needs

Develops and maintains positive working relationships

Acts as a resource to coworkers

Confirms patient identity by using the full name

Participates in problem solving groups as requested. Attends all practice staff meetings

Greeting patients, having patient(s) sign appropriate forms/consents.

Verifying and updating demographic/insurance information on all encounter forms and systems per protocol. Notifying registration of changes if applicable.

Demonstrating mastery of appropriate practice software and registration tool protocols.

Scheduling tests, procedures, referral appointments with scheduling center, agencies and/or other provider groups and forwarding order form and/or records to appropriate depart/office. Documenting information in patient's chart. Processing insurance referral/prior authorization and document this per protocol.

Retrieving and processing messages per protocol.

Assists with orientating and training/cross-training of new and established employees as assigned.

Provides coverage in other areas as needed

Effectively covers other support positions (e.g. phones, insurance referrals, scheduler) as needed

Demonstrates mastery of appropriate scheduling and registration protocols, if appropriate

Takes ownership for determining customer' needs and offering assistance

Schedules outpatient testing per orders/referral process, inputs appointment dates and times into patient EMR, if appropriate

Recognizes problems and offers constructive solutions

Performs other duties as assigned by practice leadership

Reviews material submitted by Health Plans and Managed Care Organizations to gain full understanding of benefit coverage and precertification/authorization, if appropriate

Quality review procedures are followed to ensure accounts are brought to a timely and accurate resolution, if appropriate

Ability to prioritize and perform multiple duties, simultaneously

Ability to take ownership of work and follow up on responsibilities

Speaks, spells, and writes clearly, concisely and to the point

Consistently follows Patient Identification IDD by using two patient identifiers related to the registration process

Patient Identification Manager will be alerted if duplication medical record numbers are identified

Proper name format is consistently followed

Managed care organizations are correctly identified and selected as part of the registration process, if appropriate

Timely modifications of registrations are done in order to ensure billing of encounters, if appropriate

Uses independent judgment when necessary

Assists Office Manager with patient complaints related to billing invoices, if appropriate

Appropriately refers patients/staff with issues/concerns to the direct supervisor

Performs Service Recovery when necessary

Has 100% of iCare, employee updates and any other in-services meetings and training as assigned

Maintains documented evidence of continuing education

Insurance verification and precertification is performed prior to elective inpatient admission to ensure accounts are secured upon admission, if appropriate

Names, dates, and times of conversations with businesses, insurances, managed care organizations, Utilization Review, and patients are documented, if appropriate

Insurance verification and precertification is performed on high dollar outpatient areas to ensure reimbursement, if appropriate

Understands the implication both clinically and financially of registration errors and the impact on the organization, if appropriate

Referral calls are made to PCP for Managed Care patients, if appropriate

Correct insurance is identified and selected when appropriate within the registration fields, if appropriate

Policy numbers are entered correctly into the registration fields, if appropriate

Ensures that referral authorization numbers are submitted to Patient Account Services in a timely manner and understands the implications if this is not done, if appropriate

Finishes work on time 95% of the time, avoiding overtime.

Prepares billing sheets and codes invoices prior to sending to Accounts Payable, if appropriate

Collects payments (cash, co-payments, cash, checks and other forms of payment for services rendered; reconciles cash drawer/journal per policy; promptly secures/delivers the cash deposits in the designated safe or other designated area for transit to the Fiscal Services Department, if appropriate

Oversees daily audit/cash control, if appropriate

Promotes services at Northern Light Health

Meets continuing education requirements set forth by the practice

Seeks opportunities for enhancement of skills

Assists with answering questions and directing practice staff to appropriate resources

Attends 100% of employee updates.

Other Information:

Competencies and Skills

Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.

Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.

Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.

Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

Required High School Diploma/General Educational Development (GED)

Working Conditions

Potential exposure to abusive and/or aggressive people.

Work with computers, typing, reading or writing.

Lifting, moving and loading 20 to 30 pounds.

Prolonged periods of sitting.

Prolonged periods of standing.

Prolonged periods of walking.

Position Patient Service Rep ILocation Req ID null