Patient Services Specialist I - Priority Health Care

JOB SUMMARY:

Under the direct supervision of the Senior Staff Accountant/PSS Supervisor, the Patient Service Specialist (PSS) will function as the initial point of contact for patients. The PSS is responsible for general patient support: scheduling of patients, accepting patient payments, preparing daily deposit reports, and data entry. The Patient Service Specialist will provide quality customer service to internal and external customers; review patient documentation to confirm completeness; ensure applicable check in/out procedures are being followed and patient data is entered into the practice management system timely and accurately.  The position entails answering a multi-line phone; scheduling clinic appointments and check-in/check-out; referring callers to the appropriate departments; assisting patients with forms; and performing other duties, as necessary.

MAJOR RESPONSIBILITIES/ACTIVITIES:

• Greet each patient and visitor courteously and respectfully. 

• Schedule patient appointments and make reminder calls. 

• Answer phones promptly and courteously, following all protocols set up with transferring calls to departments. 

• Register patients accurately and in a timely manner making sure all information is correct. 

• On every visit, ensure insurance is verified at the time of registration and all applicable signatures are obtained. 

• Collect applicable co-pays/co-insurance/deductibles, post payments, give receipts, make change, give applicable discounts, and balance daily batch. 

• Obtain referrals and clarify coordination of benefits on every referral. 

• Check patient eligibility and insurance plan benefits via online payer portals and/or outgoing calls to the insurance plans. 

• Complete benefit verification with the electronic medical record's (EMR) system. 

• Assist patients in completing patient history forms, consent forms, and payment contract forms, when necessary. 

• Monitor patient wait times both before and after registration keeping them notified of any delays and waits. 

• Direct patients and visitors to appropriate areas obtaining assistance from fellow employees for those patients and visitors that are unsure of where they need to go within the facility. 

• Obtain assistance for patients and visitors needing special help. 

• Utilize the EMR's messaging system to speak with staff regarding patients. 

• Document all pertinent communication with patients, physicians, insurance companies as it may relate to collection procedures. 

• Monitor alarm controls. 

• Maintain effective working relations with coworkers, utilization review, outside companies, and other staff to ensure workflow effectiveness. 

• Understand the nature of programs and services to approach job and responsibilities with a sense of caring and urgency.  

• Deliver outstanding customer service to internal and external customers with a communication style that is professional and courteous.  

• Maintain confidentiality and knowledge of HIPAA (Health Insurance Portability and Accountability) regulations. 

• Stay abreast of industry changes and regulations to ensure adherence and proactive preparedness. 

• Conduct all job tasks, duties, and interactions with professionalism, respect, a positive attitude, and in accordance with company compliance policies and applicable government regulations. 

• Consistently support and demonstrate the company's mission and values. 

• Perform other related duties as assigned. 

OTHER RESPONSIBILITIES/ACTIVITIES:

• Demonstrates a positive attitude.  

• Foster teamwork by offering assistance to others.  

• Acknowledge and respond tactfully to all requests.  

• Show consideration in interaction with patients, family, and other healthcare team members by demonstrating listening skills and cooperation.  

• Communicate and interact with others in a professional, responsible, cooperative, and positive manner. 

• Completion and/or involvement in special projects. 

• Participation in relevant meetings and company-sponsored events. 

EDUCATION & EXPERIENCE:

• High school graduate or General Education Degree (GED) required. Vocational training in health care related fields a plus, some work-related experience with billing and accounts receivable preferred. 

• Understand insurance benefits including copays, deductibles, and coinsurance. 

• Experience with and knowledge of FQHCs billing (Federally Qualified Health Centers) preferred. 

SUPERVISORY RESPONSIBILITIES:

• N/A 

QUALIFICATIONS:

• Knowledge of accounting; math skills. 

• Basic knowledge of Medical and Billing Terminology. 

• Basic knowledge related to electronic claims submissions and remittance procedures. 

• Experience working with practice management software. 

• Knowledge of healthcare carriers and payer requirements. 

• Knowledge of Medicare, Medicaid, compliance, insurance, liability, and tertiary payment methods. 

• Intermediate knowledge of Excel and Windows-based programs. 

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements in this document are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

PERFORMANCE REQUIREMENTS:

• Works at the established productivity levels with accuracy and timeliness. 

SKILLS & ABILITIES:

• Strong organizational, quantitative skills and analytical skills. 

• Demonstrated accuracy with a strong attention to detail. 

• Excellent work ethic and ability to prioritize tasks. 

• Detailed and process improvement oriented. 

• Excellent problem-solving skills. 

• Ability to present findings and discuss issues with providers effectively. 

• Ability to work independently and as a part of a team in a deliverable-focused professional environment. 

• Ability to shift focus as necessary when priorities change without losing sight of original assignments. 

• Willing and able to work extended hours as business needs require. 

• Strong sense of confidentiality and professionalism regarding company and employee information. 

• Strong problem-solving and analytical skills that demonstrate resourcefulness and initiative. 

• Strong listening, decision-making, time management, communication, and critical-thinking skills. 

• Performance-driven with demonstrated ability to multi-task and work proactively with cross-functional teams. 

• Proficiency with Microsoft Office programs particularly excel. 

REQUIRED CERTIFICATIONS AND LICENSURES:

• N/A 

PREFERRED EDUCATION, CERTIFICATIONS & EXPERIENCE:

• N/A 

LANGUAGE SKILLS:

• Ability to read, write, speak, and comprehend written documents fluently. 

MATHEMATICAL SKILLS:

• Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. 

REASONING ABILITY:

• Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. 

WORK ENVIRONMENT:

• This job operates in a healthcare setting. This position requires frequent standing and walking. 

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation will be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. 

• This job description includes the major duties and responsibilities of the job but is not inclusive of every task inherent to the job. In addition, it may be occasionally necessary for employees to be assigned tasks not specifically covered by their permanent assignment. Employees will be expected to comply with reasonable requests from their supervisor.  

PHYSICAL DEMANDS:

• The majority of time is spent in a normal office environment. 

• Possession of motor skills required for use of computer keyboard, telephone, various office equipment and filing of paperwork. 

• Flexibility to work extended hours to support the business as required. 

• Occasional travel required, sometimes on short notice. 

• PHC will comply with the Americans with Disabilities Act, including the Americans with Disabilities Act Amendment Act, and all other Federal, State, and local legislative requirements. PHC will ensure that reasonable accommodations are made to enable a qualified individual with a disability to perform the essential functions of that position. 

COMPETENCIES ESSENTIAL FOR SUCCESS:

• Ethics/Company Values 

• Communication 

• Developing/Coaching Others 

• Maturity/Judgment 

• Intellectual Capacity 

• Technical/Business Knowledge 

• Planning/Organization 

ACKNOWLEDGEMENT: 

Priority Health Care is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ethnicity, citizenship status, religion, age, gender identification, pregnancy, marital or familial status, gender or sexual orientation, veteran or military status, physical or mental disability, genetic information, or on the basis of any other status protected by law, and in compliance with applicable federal, state and local laws. 

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