Patient Services Representative (Rehab)
Wellstar Health Systems

Facility: Wellstar GME Internal Medicine Clinic

Job Summary:

Functions in a customer service role and responsible for day-to-day operations of the front office area. This includes pre-registration/registration of new patients, scheduling, and general clerical support. Cross trained in all functions and processes of front desk to ensure the smooth operation of the Department. Local travel may be required.

This job is typically the first point of contact and must ensure a pleasant compassionate and empathetic experience for patients and visitors. The Patient Representative interviews patients and/or their representatives to obtain complete and accurate demographic, financial and insurance information, required for billing and collecting patient accounts. Conducts intensive screening of all worker's compensation, Medicare, Medicaid and managed care patients for pre-certification requirements and provider service eligibility, prior to registration as applicable. Obtains all necessary customer consents/attestations.

Maintains a working knowledge of insurance benefits and coverage verification. Coordinates the collection of estimated patient liabilities, including co-payments when applicable. Responds to customer requests and answers questions regarding various service and account information. Analyzes and rectifies customer concerns using established procedures. Uses computer to access and/or update customer confidential patient records.

Must be competent in multiple clerical functions, including: answering multi-line phone system, registering returning and new patients accurately, prepare patient paperwork, verify commercial and government insurances, understand the breakdown of insurance benefits and when authorization may be required per payor requirements, able to review insurance benefits with patient, detail orientated to accurately update and maintain data entry into spreadsheets, maintain inventory of supplies and order when necessary, understand and work in EPIC and OP Rehab EMR System.

Reviews and accurately verifies and post payments through EPIC and OP Rehab EMR. Follows WellStar and PAS policy for processing receipts, cash, and end of day closing of cash drawer. Must be able to effectively sort, organize, and maintain various documents to support front office functions and procedures. Refers patients to financial counselor to establish financial arrangements to reduce financial risk for WellStar, helping to ensure that WellStar is reimbursed for its services.

Core Responsibilities and Essential Functions:

• Functions at a professional level during interaction with all customers and co-workers:
  
• Receives requests for appointments from physicians offices and/or employers and makes the necessary pre-admission arrangements, referring to lists of dates allotted for scheduling, and advising physicians office staff and patients of available dates.
  
• Greet all guests with a positive and professional attitude.
  
• Arranges to have patients escorted to procedure areas and/or assigned rooms.
  
• Maintains confidentiality of patient information in accordance with WellStar policy and HIPAA regulations.
  
• Presents a well-groomed and professional image.
  
• Must follow WellStar and Outpatient Rehab Dress Code Policy.
  
• Answers incoming phone calls and routes to appropriate parties or addresses issues as directed.
  
• Assists physicians (and their office staff) as well as patients to expedite scheduling, pre-registration, pre-certification and/or prior authorizations.
  
• Maintains courteous and cooperative working relationships with patients/families, co-workers, management, physicians, other professionals, and the general public.
  
• Demonstrates the ability to tactfully handle difficult situations.
  
• Completes registration process per WellStar policy and regulatory standards.
  
• Interviews each patient or representative in order to obtain complete and accurate demographic.
  
• Financial and insurance information, and accurately enters all patient information into the registration system.
  
• Reads physicians orders to determine services requested and to assure order validity.
  
• Obtains new medical record numbers for all new patients.
  
• Obtains all necessary signatures and is knowledgeable regarding any special forms that may be required by patients third party payor.
  
• Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances clarifying special billing processes.
  
• Re-verifies all information at time of registration process.
  
• Understands and applies WellStar philosophy and objectives and Rehab and PAS policies and procedures, as related to assigned duties. Understands the outpatient registration processes.
  
• Works with IT/ EMR on troubleshooting Registration interface errors.
  
• Maintains a working knowledge of the process to verify insurance coverage and benefits.
  
• Assist in verifying benefits as needed and all patients end of year.
  
• Professional and knowledgeable communication to patient regarding benefits.
  
• Completes all revenue collection efforts according to WellStar and PAS policy.
  
• Contacts patients prior to initial visit to discuss co-pay and/or self-pay arrangements.
  
• Collects the co-pay amount at each visit and provides a receipt to the patient.
  
• Balances collection log and receipts at end of each business day.
  
• Explains prompt payment discount policies to self-pay patients.
  
• Routes self-pay patients to financial counselor for financial arrangements of self-pay balances, as indicated.
  
• Makes corrections and updates patient account information in computer as necessary.
  
• Documents concise and understandable notes regarding self-pay and co-pay collection activity as indicated.
  
• Timely communicates on all charge addendums.
  
• Works efficiently and accurately within designated time frame to ensure a continuity of information and patient flow.
  

• Prepares charts for the clinic in a timely manner.
  
• Consistently demonstrates the ability to organize work, recognize and establish appropriate work priorities, and complete work in a productive manner, without creating backlogs.
  
• Maintains proficiency and accuracy in data entry skills.
  
• Maintains a working knowledge of available information system capabilities and performs all system applications that are required.
  
• Faxes, mails or otherwise provides medical information to referring physicians in a timely manner, as per departmental process.
  
• Accurately provides information to medical record company as requested for review of claims, as per departmental process.
  
• Effectively utilizes and daily maintains all office equipment, phone system and intercom system and PC.
  
• Keeps management (Lead PSR, Clinic Supervisor, Admin) informed of all necessary information; reaches out for assistance as needed.
  
• Tracks financial/clinical statistical data as per departmental requirements, and functions in a clerical support role for department. (Typically, this is assigned to only one PSR when there are multiple PSRs in the same department. In that case, this staff members other job responsibilities are reduced to accommodate for these tasks.)
  
• Works EPIC work queues and reports daily per demands.
  
• Analytical skills to effectively complete all denials in a timely manner, collaborating with other departments as needed.
  
• Prepares and maintains accurate statistics consisting of visits, new patients, procedures, revenue, patient satisfaction, etc. for the department.
  
• Submits daily, weekly and/or monthly reports of statistical information to administration.
  
• Utilizes Lawson or other method appropriately to maintain departmental ordering/inventory process.
  
• Provides secretarial support to manager and clinical staff in a timely manner, maintaining appropriate confidentiality.
  
• Records and maintains minutes of monthly minutes of monthly departmental meetings.
  
• Maintains educational records for department, including entering educational information into Kronos Timekeeper.
  
• Creates charts, forms, reports and other documents on PC.
  
• Performs other duties as assigned
  
• Complies with all WellStar Health System policies, standards of work, and code of conduct.
  

• High school diploma or equivalent Required
  

• Previous employment record reflects work stability, as indicated by an average work tenure for previous jobs of at least one (1) year. Required
  
• Minimum 2 years of related experience in healthcare work setting, with exposure to front office responsibilities, insurance verification and insurance authorizations Preferred
  

• Typing and data entry competency;
  
• Work with minimal direction after training;
  
• Basic computer skills;
  
• Insurance terminology and knowledge, pre-certification/authorization process, medical terminology and ICD 10 knowledge preferred;
  
• Familiarity with routine office equipment and Microsoft Office.
  
• Demonstrated professionalism, effective communication skills and active listening.