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Job CategoryPatient Services
Job FamilyPatient Support
DepartmentRCH Revenue Cycle Management Services
Scheduled Weekly Hours40
Job SummaryThe Patient Services Specialist expedites and enhances patient access to care by scheduling diagnostic outpatient services in real time and financially clear patients prior to date of service. Financial Clearance to include completing insurance verification, pre-certification, authorization, pre-registration, notification to the patient or responsible party of estimated amount due for services provided by both the clinic and the facility, and collection of prepayment.
●Accurately identifies patient from the Master Patient Index, if applicable as evidenced by documentation.
●Responds to telephone calls in a timely manner. Speaks with a pleasant and professional voice when on the telephone. Interprets the caller’s needs and offers assistance as evidenced by observation and feedback.
●Ensures all Critical Data Elements are obtained and input correctly in required areas to include multiple EMR’s for efficient, accurate and complete billing.
●Schedules appointments promptly and courteously and makes all attempts to meet the patient’s expectations. Obtains patient information (name, date of birth, diagnosis, ordering physician). Indicates patient information on the patient schedule.
●Communicates the need for preauthorization for exams prior to completion of exam scheduling.
●Demonstrates knowledge of third party payer information, including Medicare, Medicaid, VA, Tricare/UHC and commercial payers, to ensure compliance with rules and regulations to ensure accurate reimbursement. Utilizes available tools to identify third party payers and verifies current insurance eligibility in the most efficient manner possible. This could include Passport, EHR, insurance websites, telephone, or fax.
●Contacts third party payer and verifies coverage, obtaining preauthorization when required.
●Contacts patients to discuss estimate of amount due in a friendly and professional manner.
●Collects prepayments prior to services provided, amount to be determined based on percentage of amount due. Records any collected payment according to department policies and procedures.
●Identifies patients at high risk for financial clearance and patients requesting assistance, assist patient in completing financial assistance paperwork, provide counseling for payment arrangement and act as a liaison between the patient and patient accounts department. Efficiently and effectively communicates with clinical staff to include nurses and providers regarding delays in clearance process which may postpone patient care.
●All other duties as assigned.
Education - High School Diploma/GED Equivalent in General Studies
Experience - 1+ years of Billing/Collections Experience; 1+ years of Customer Service Experience; 1+ years of Scheduling Experience
Education - Associates degree in Healthcare
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.10 Monument Health Rapid City Hospital, Inc.
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