The Patient Services Representative accepts patient referrals; schedules appointments and maintains data in a computerized scheduling program; preregisters the patient and creates accounts for clinical services; verifies and or obtains authorization for services; creates and maintains patient charts; and ensures that the patient account is ready for billing.
Accepts referrals, verifies for completeness and appropriateness, communicating with referral sources to obtain additional information as needed. Creates and maintains patient charts. Assures that charts contain MD referral orders, past medical records, documents required for clinical use, documents for patient signature. May assist clinical diabetes staff by downloading patient meters. May compile and report units of service data to Finance for productivity reports. Obtains confidential information from patient or family member, including demographic, financial, and medical. Pre-registers patients into the patient accounting system, verifies insurance, verifies co-payment requirements and obtains/completes all necessary authorizations, certifications, notifications and government required documentation.
Prepares charge tickets for clinical services. In selected centers, audits every patient chart for chargeable services and takes corrective action to ensure they are accurate and complete. Researches and clears problems identified by patient accounting systems required to ensure complete and appropriate billing of assigned claims. May post billing charges and collection of cash/credit receipts to patient accounts. May translate narrative diagnosis into ICD-9 codes and enter into billing system.
Schedules patients for initial and follow-up appointments and maintains data in computerized scheduling program.MINIMUM QUALIFICATION REQUIREMENTS Education/including Licensure/Certification/RegistrationCurrent Basic CPR for Infants, Children, and Adults is required in some settings. Certified Billing Coder preferred. High school graduate or equivalent required. Certification, Associate or Bachelors Degree in Business or Healthcare related field preferred. Knowledge:Requires understanding of health insurance concepts and requirements, including HMO, PPO, Medicare, Medi-Cal, and other federal and state agency programs. Requires knowledge of medical and billing terminology. Experience:Requires experience in a health care setting or insurance related field providing patient registration and/or insurance authorization as typically obtained in approximately 2 years is strongly desired. Strong customer service experience preferred. Skills:Required to collect a variety of information in an extremely accurate manner in a fast paced environment, while maintaining patient confidentiality. Must be able to use various complex tools to register and schedule patients. Must be highly skilled in verbal and written communication. Strong computer skills required. Requires math skills. Requires customer service skills. Requires attention to detail. Must have ability to hear with or without assistive devices.