Patient Financial Services Representative

Position Summary: This position is the frequently the first contact a patient has with the HMC system.  This position is required to make outbound calls to patients who have been scheduled for services at HMC. The responsibility of this role is to contact the patient and to accurately collect all required information necessary to meet state/federal regulations and to satisfy HMC billing processing requirements, including insurance coverage. This position also performs a process by which an estimate of patient responsibility is created based on the insurance coverage and the type of service scheduled to be provided. In addition, this position may also request payment at this time and process the collection. This position requires excellent customer services skills and an ability to be able to explain to people what information is necessary and the rationale.

Responsibilities:

• Collection of demographic information using Meditech (Electronic Medical Record)
  • Collect basic personal information from patient including age, race, ethnicities
  • Collect addresses, phone numbers and other contact information
  • Collect next of kin information
  • Collect insurance/coverage information. Be able to discern what information is required based on type of insurance, i.e., on the job injury, motor vehicle accident, etc.
  • Sequence the insurance in the correct order according to guidelines
  • Based on specific criteria, request additional information, i.e. MSPQ/COB
• Verification of insurance coverage using AccuReg
  • Review feedback from AccuReg for any issues related to non-coverage or data accuracy
  • Review with the patient any feedback and reconcile accordingly
  • Ability to decipher the appropriate action based on AccuReg feedback, i.e., change the information in Meditech or enter a dispute so a more senior person can review
  • Verify insurance prior to the call
• Verification if no available coverage 
  • Confirm if patient is self-pay
  • Be able to direct patient to appropriate resources for assistance, if necessary
• Creation of patient liability estimation using AccuReg
  • Determine the appropriate amount based on insurance and type of service
  • Provide an explanation to the patient of how the amount was calculated, if requested
• Collection of patient liability
  • Request patient payment adhering to HMC guidelines on point of service collections
  • Provide options for patient if not collected at time of phone call
• Provision of basic information
  • Explain full registration at time of service; bring cards, bring payments
  • Provide any preparation requirements as dictated by HMC
  • Offer parking/entrance advice based on service location or registration site
  • Discussion of patient portal and digital registration processes
• Documentation of the interaction
  • Completing all the required fields and making accurate and complete notes to assist the HMC colleague who completes registration on site

Qualifications: 

• Required
  • High school diploma or equivalent is required.
• Preferred           
  • One year of working in healthcare office setting 
  • Accuracy and attention to detail. Proactive approach to problem-solving and process improvement.
  • Strong verbal and written communication skills, good organizational skills, efficient in computer operations including Microsoft Word, Excel, and Teams.
  • Professional and courteous demeanor, excellent office and phone etiquette.

Patient Interaction: Continuous

HIPAA: This position will have access to the following Protected Health Information in order to perform the duties related to their position at Hays Medical Center based on the following criteria:

•  
• Primary – required (routine) to do the job
  • Patient demographics
  • Insurance/Coverage information:
  • Scheduled service/provider
  • Secondary   - occasionally necessary to perform the job
  • None- no approved access
    • Clinical information beyond type of service
    • Coding
      
      Description of Information
      Primary:
      Patient Demographic Information (information used to identify a person): Name, Date of Birth, Address, Race, Marital Status, Religion

Secondary:

Clinical Information (information that describes a patient’s health status): Diagnosis, Reports/Medical Notes, Test Results, Problem List, Procedures, History and Physical

Coding Information (clinical information that is in (alpha) numeric format): ICD-9 Codes, Rev Codes, CPT Codes

Financial Information/Insurance (information related to insurance, billing and payment): Billing Information, Payer Name, Payer ID, Account Balances, Plan Elements Covered, Payment Information, Payment Rates