Patient Services Representative

POSITION PURPOSE:
Ensures patients and customers are processed in a professional, timely and efficient manner, and accounts are created accurately and efficiently in order to optimize cash flow for hospital revenue, exceed customer expectations and comply with all state and federal regulations and laws throughout the processes of scheduling confirmation, pre registration/pre admission, registration/admission, insurance verification, receipting of payments, and escorting, in a timely, organized, courteous, and professional manner.

QUALIFICATIONS:

• High school diploma or equivalent
• Independent problem-solving skills
• Must possess computer and typing skills
• Must have knowledge of correct telephone answering techniques
• Previous receptionist experience preferred
• Minimum 3 years customer services experience preferred

GENERAL REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed below are representative of the knowledge, skill, and / or ability required:

• Ability to add, subtract, multiply, and divide
• Ability to generate, read, interpret, and take action as it relates to basic financial statements, national and state regulations, safety rulings, operational and maintenance and organizational policies / procedures
• Ability to write reports and correspondence
• Ability to effectively present information to patients, families, employees, health care providers, etc...
• Ability to work cooperatively and communicate effectively to maintain good working relationships with staff and health care providers
• Ability to work with skill in identifying problems; making frequent decisions regarding method of performance

EQUIPMENT, TOOLS, MATERIALS:

• Calculator
• Computer and printer
• Fax and copy machine
• General office materials/supplies
• Information Systems
• Telephone system

SECURITY/ACCESS:

• Will have access to the facility 24 hours a day.
• Will have access to confidential information abiding by the organizations privacy policies and regulations concerning this information.

Essential Job Duties and Responsibilities

1. Performs account creation and registration tasks in accordance with established policies to obtain complete and accurate demographic and insurance information.

• Reviews registration follow-up reports for Patient/Guarantor Information and Insurance Information.
• Scans report for errors and corrects them in the computer.
• Monitors census edits and makes correction as needed.

2. Maintains and demonstrates current working knowledge of established policies and procedures and carries out all operational processes of Admissions in an accurate and efficient manner.

• Pre-admits and admits patients by gathering all insurance and demographic information.
• Verifies insurance through CPSI eligibility verification.
• Explains the consent to treat form and all other paperwork associated with the admission to the patient at the time they are signing the admissions paperwork.
• Scans copies of insurance cards, drivers licenses, etc. to assist in processing of claims once admissions and patients visit is completed.
• Updates addresses and various patient information to keep computer database as up to date as possible.
• Assists patients and visitors with directions to area of service upon request.
• Collects co-pays and payments or directs private pay customers to the [position - Financial Service Representative] for setting up a payment plan.
• Updates doctor master information as changes are made and requested.

3. Maintains current file/listing of patients by name and room number, emergency phone numbers of on-call personnel, department extension, key personnel, etc.

• Stays informed of changes in major insurance plans, deductibles, coinsurance, and non-covered benefits.
• Seeks and reads information to obtain latest information.
• Takes responsibility for maintaining notes and information to enhance accuracy and knowledge base.

4. Provides support in the areas of admissions, patient account services and customer service.
Maintains and updates insurance files for patients.

• Completes and updates the daily census sheet as needed.
• Provides information to all customers by phone, pagers or other communication media.
• Answers telephone calls and related questions in a professional manner.
• Gives directions/information to visitors, patients, residents, sales representatives, etc
• Assists with administrative duties including: typing, filing, etc
• Maintains and updates insurance files for patients.
• Completes and updates the daily census sheet as needed.

5. Arranges payment plans for persons indebted to the Hospital and Clinic, including employee payroll deduction forms for account payment.

• Prepares promissory notes and obtain the proper signatures on them.
• Discusses OB package prices with patients and prearrange for payment.
• Assists with credit card payments, credit balance resolution and returned or insufficient fund checks.

6. Gathers information on accounts eligible for charity assistance.

• Provides initial assessment of qualification to be presented for approval.
• Sends letters of approval or denial for charity assistance.
• Maintains working knowledge and stays current with changes to major insurance plans regarding deductibles, coinsurance, co-pays and non-covered services.

7. Follows HIPAA regulations and ensures that the confidentiality of patients medical, personal, financial records, employee records, and organizational records is maintained.

8. Participates in FCH committees, quality assurance, performance and quality improvement initiatives, and activities which support the facility and department operations.

9. Complies with the state and federal regulatory requirements related to the performance of FCH operations and requirements of the FCH Compliance Program. Including but not limited to:

• The Compliance Policy.
• Completes all on-line training annually and as assigned.
• All department and organization-wide policies.
• Considers the impact of regulations such as Critical Access Hospital requirements, along with Federal and State of Nebraska regulations and discusses concerns appropriately to ensure compliance.

10. Presents self in a professional manner and enhances professional growth and development through participation in education programs, current literature, in-service meetings and workshops.

• Seeks opportunities for continued growth and performance improvement.
• Always maintains a professional appearance and manner.
• Dependable and completes work in a timely manner.
• Demonstrates an understanding and emphasis on quantity, quality and knowledge of duties and tasks.

11. Performs other duties as assigned.

Essential Standards of Service Excellence

1. Abides by Fillmore County Hospitals Standards of Professional Courtesy and Respect which include:

• Communication & Interaction
• Customer Service & Respect
• Teamwork
• Telephone Communication
• Safety, Pride &Ownership
• Professional Appearance

2. Abides by Fillmore County Hospitals Core Values 1-12 which include:

• Authenticity
• Integrity
• Awareness
• Courage
• Perseverance
• Faith
• Purpose
• Vision
• Focus
• Enthusiasm
• Service
• Leadership

ESSENTIAL WORK ENVIRONMENT & PHYSICAL REQUIREMENTS:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.