Patient Service Representative

Under limited supervision, determines need for and obtains authorization for treatment /procedures and assignment of benefits required. Provides information to patients concerning regulatory requirements. Provides estimated costs and patient responsibility, facilitating collection of co-pay, deductible and private pay balances. Responsible for the complete and accurate collection of patient demographic and financial information for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and checks-in patients and determines preliminary patient and insurance liability. Performs account analysis, problem solving and resolution of patient account issues. Initiates billing and rebilling of accounts as appropriate.

• Interviews patients and gathers information to assure accurate and timely claims submission.
• Interprets information collected to determine and create comprehensive visit-specific billing records.
• Determines need for and obtains authorization for treatment/procedures and assignment of benefits as required.
• Maintains competency by participating in on site and external training opportunities. Utilize skills gained from training sessions to improve and enhance their work processes and customer interactions.
• Provides information to patients concerning hospital policies and regulatory requirements utilizing effective interpersonal and guest-relations skills.
• Provides assistance to other Health System or physician offices staff regarding registration, insurance verification and authorization requirements and processes.
• Determines appropriate payment required at point of registration (deposits, co-pays, minimum charges and non-covered services.) Collects payment at time of registration or check-out.
• Based on planned services provides estimated costs and patient responsibility for both procedural and complex services. Documents communication with patients related to estimates within the patient accounting record.
• Verifies procedural and diagnosis codes submitted by service departments and physicians to assure accuracy for claims submission and adjudication of reimbursement.
• Verifies insurance eligibility with payors. Determines benefits and ensures authorization requirement are met. Interacts with ordering practitioner and patient to coordinate service and insurance requirements.
• Contacts patients to discuss eligibility and benefits and requirements specific to clinical services. Creates appropriate registration record. Communicates with patients their financial responsibility, benefit and authorization status prior to clinical services.
• Facilitate cash collection as appropriate prior to and at the time of service, including copays, deductibles, and private pay responsibility.
• Obtains insurance authorization, patient liability acknowledgement, acknowledgement of non-covered services and advance beneficiary notices and consent forms. Explains the purpose of these forms to patients and responds to question related to their intent. Completes as required; obtains signatures and approvals; verifies that information is complete and accurate.

REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE

Education: Requires high school diploma or equivalent.

Experience: One or two years related experience.

Certification/Licensure: CHAA certification from National Associate Healthcare Access Management preferred.

REQUIRED SKILLS AND ABILITIES

Demonstrated computerized system application experience. Critical thinking and problem-solving skills.

Analytical ability to affective and efficiently resolve registration, insurance and claims processing issues.

Demonstrated knowledge of revenue cycle processes and terminology. Interpersonal skills to effectively communicate with patients, team members, clinical colleagues, medical staff, third party providers, and external agencies and contacts.

Exceptional customer service skills and positive personality attributes. Patience in dealing with ordinary, arduous or emotional patients. Use of telephones.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.