Patient Service Center Representative

Company: Bryan Health
Location: Lincoln
Posted on: January 17, 2020

Job Description:

GENERAL SUMMARY:

The Patient Service Center Representative is responsible for a broad spectrum of duties beginning with the initial receipt of core data elements and completion of the pre-registration process. This information includes personal demographics, insurance verification, pre-certification authorizations, service charges, financial counseling, and any needed patient financial education. Performs a financial review of patient information in order to identify self-pay and uninsured cases. Ensures urgent/emergent cases are worked within one business day of admission and all elective cases worked prior to date of service. Refers Worker's Compensation and uninsured accounts to appropriate agency within 48 hours of admission. Performs financial review of patient encounters and prepares patient liability estimates. Ensures patients are fully aware of financial obligations and eligibility or programs that may provide financial aid; explains and collects co-pays, deductibles and other patient balances; provides patient education regarding third party coverage and liabilities.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Serves as work resource and liaison to hospital departments, physician offices, and patients for pre-service authorization or financial responsibility questions.

3. *Adheres to federal regulations regarding Advance Directives, COBRA, Medicare, Corporate Compliance, Joint Commission, OSHA and HIPAA; reports safety and customer concerns.

4. *Verifies third party insurance coverage from pre-registration, daily admissions and scheduling databases; updates appropriate software systems.

5. *Confirms demographic and insurance data is complete, accurate, and verified on reservations; identifies patterns of errors and makes recommendations for improvement.

6. *Ensures that pre-certification and/or authorization and referral requirements have been completed by placing phone calls to insurance companies, physician offices, patients, and utilizing web based applications and/or internet resources; obtains clinical information from physician offices and/or Bryan system; contacts Health Information Management to obtain CPT and/or ICD-9 codes.

7. *Notifies CM when eligibility and/or benefits are complete on applicable admissions; notifies CM about Medicare Dental Carries patients.

8. *Supports the financial goals of Bryan Medical Center by communicating to and collecting from patients insurance, deductible amounts; identifies underinsured, uninsured and self-pay patients for immediate referral to financial counselors or general assistance.

9. *Provides patient estimates and discusses payment options pre-service.

10. *Describes medical center payment policies and expectations, and provides financial options; explains insurance coverage and responsible party obligations.

11. *Explains notice of non-coverage or offers to re-schedule elective tests and procedures, when patient's pre-authorization is not obtained; notifies patient and physician of outcome; appeals to insurance company when denial is received and conducts follow-up as appropriate.

12. *Coordinates obtaining waiver of liability when third party payers deny coverage or services that are non-covered.

ADDITIONAL JOB FUNCTIONS:

In addition to the principal job functions contained on the primary job descriptions, the following duties are also required in the department noted above.

* *Facilitates authorization process with offices and providers.

* *Serves as work resource and liaison to hospital departments, physician offices, and patients for pre-service authorization or financial responsibility questions

* *Verifies third party insurance coverage from pre-registration, daily admissions and scheduling databases, updates appropriate software systems.

* *Ensures that pre-certification and/or authorization and referral requirements have been completed by placing phone calls to insurance companies, physician offices, patients, and utilizing web based applications and/or internet resources; obtains clinical information from physician offices and/or Bryan system; contacts Health Information Management to obtain CPT and/or ICD-9 codes.

* *Notifies CM when eligibility and/or benefits are complete on applicable admissions; notifies CM about Medicare Dental Carries patients

EDUCATION AND EXPERIENCE:

High school diploma or equivalency required. Associates degree preferred. One (1) year of relevant work experience (i.e. hospital billing or insurance) required. Must be 19 years of age to witness legal consents.

Bryan Health is an Affirmative Action/Equal Employment Opportunity Employer. Employment decisions are made without regard to race, religion, age, color, sex, national origin, disability, genetics, marital, disability and/or veteran status. Bryan Health hires and promotes individuals solely on the basis of their qualifications for the job to be filled.

Keywords: Bryan Health, Lincoln , Patient Service Center Representative, Sales , Lincoln, Nebraska