Patient Service Representative I

ESSENTIAL FUNCTIONS

• Greet patients, families, and visitors in a courteous and professional manner.
• Answer and route incoming patient calls promptly and professionally.
• Maintain a clean and organized front desk area.
• Maintain confidentiality and compliance with HIPAA and hospital policies.
• Assist with other clerical or administrative tasks as assigned.
• Maintain a clean and organized work environment and ensure supplies are stocked
• Collaborate with other departments to ensure smooth patient flow and timely service.
• Initiate and announce overhead emergency codes, including "Code Red" in the event of fire or smoke detection, following facility procedures.
• Respond calmly and appropriately to emergency situations, including notifying security and/or emergency response teams.
• Collect and verify patient demographics, insurance information, and required documentation.
• Input accurate patient data into the hospital EMR system.
• Obtain patient signatures for consent forms, insurance authorizations, and privacy acknowledgments.
• Provide patients with information on hospital policies, procedures, and financial responsibilities.
• Coordinate with clinical and billing departments to ensure proper patient flow and documentation.
• Respond to patient and visitor inquiries and resolve registration issues efficiently.
• Confirm and document insurance information to reduce the risk of claim denials.
• Explain financial responsibility to patients when appropriate.
• Accept and process payments for co-pays or deposits, when necessary.
• Be familiar with individual payor guidelines and the process of collecting over the counter payments/deductibles/co-pay/coinsurance. Knowledge of payor contracts including Medicare, Medicaid and other government contracts and guidelines.
• Investigate questionable information promptly, i.e. MVA and work comp information that conflicts with insurer information.
• Notify Business Office Manager and Physician Office of any benefit, financial or authorization concerns or issues immediately.
• Work two weeks ahead of surgeries to avoid late notice cancellations.
• Contact patients with financial responsibility information and works out payment arrangements prior to patient arrival.
• Review entered information with patient to ensure accuracy.
• Scan photo identification and insurance card(s) into EMR. Make any corrections to insurance information upon review of insurance card(s) when necessary.
• Request Living Will/Advance Directives. Provide information if requested on where to obtain information on said forms to patient.  Document when patient requests information and that it was provided in order to meet state and Joint Commission requirements.
• Complete Medicare MSP questionnaire when necessary.
• Collect patient responsibility upon admission.
• Obtain patient signature on required forms.
• Print labels and wristband and Facesheets. Review patient information with the patient and confirm accuracy before applying the wristband.  Take chart with labels to Pre-op to notify nurses that patient is registered.
• Meet or exceed monthly, quarterly and yearly cash collection goals.
• Discusses patient information with other health team members in an appropriate environment.
• Interacts with all patients, families, visitors and fellow teammates in a mature, responsible manner to ensure a positive and professional facility environment.
• Must have a clear understanding of KPI and Metric’s measures and ability to complete daily tasks to meet Departmental and Hospital measures.
• Schedule, reschedule, and cancel imaging appointments as needed
• Communicate prep instructions for various imaging procedures (e.g., MRI, CT, Ultrasound)
• Coordinate with imaging technologists and other departments to ensure proper patient flow
• Answer phones, respond to inquiries, and relay messages promptly
• Other duties as assigned

EDUCATION

• High School Diploma or equivalent (required).
• 1–2 years of experience in a hospital, medical office, or customer service setting (preferred).

EXPERIENCE

• Familiar with and understand Medicare, Medicaid and other government payors and HMO/PPO payors guidelines and principals.
• Understands benefits (ie: deductibles, copays, and coinsurance) and how to calculate estimates per the payor contract as applicable.
• Patient registration in a medical office, hospital or outpatient surgery center preferred.

REQUIREMENTS

The job holder must demonstrate current competencies for the job position.

KNOWLEDGE

• Medicare, Medicaid and other government payor guidelines.
• Clear understanding of insurance benefits and how to calculate patient responsibility.
• Patient Registration.

SKILLS

• Strong customer service and communication skills.
• Ability to work in a fast-paced environment and multitask effectively.
• Proficiency with computers and EMR systems
• Detail-oriented and organized.

ABILITIES

• Ability to communicate patient responsibility clearly with patients, communicate with physician’s office staff, payors and hospital teammates.
• Ability to resolve issues in a professional manner.
• Ability to work independently with minimal supervision.

ENVIRONMENTAL WORKING CONDITIONS

Indoors in a climate-controlled environment.

PHYSICAL/MENTAL DEMANDS

• Ability to sit, stand, and walk for extended periods.
• Manual dexterity for using office equipment (phones, keyboards, scanners).

• Ability to lift 15 lbs.
• Good hearing
• Clear articulate speech
• Visual acuity

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision and Values must be read and signed.
• OSHA Requirements and training to include:
• Annual Safety Training

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.