Patient Service Representative II - AHWFB Plastic Surgery

Atrium Health; Winston-Salem (NC); On-site; USD 62,774,000 - 93,985,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Educational assistance

Job summary

Advocate Health Wake Forest Baptist and partners seek a dedicated Patient Services Specialist to manage patient registration, verify insurance, and pre-certify services in a fast-paced clinical setting. You will pre-register patients, handle referrals, and support billing processes while ensuring privacy and accuracy.

The role requires HIPAA compliance, strong communication, and the ability to handle escalating issues with professionalism.

Qualifications

• High school diploma or equivalent with 3 years in customer service in a fast-paced environment.
• Experience handling high-volume calls or in-person requests.
• Knowledge of HIPAA compliance and patient data privacy.

Responsibilities

• Interview patients in-person and/or by phone to obtain required information for hospital records and billing systems.
• Verify insurance coverage and obtain pre-certifications as needed.
• Process referrals and perform clerical tasks (phones, messages, chart processing, faxing, scanning).
• Collect deposits or set up payment arrangements as required.
• Screen for Medicaid, ACA, or hospital financial programs and provide documentation and referral.

Skills

Patient access expertise

Communication skills

HIPAA compliance

Critical thinking

Escalation handling

Mentoring teammates

Microsoft Office

Problem solving

Education

High school diploma

Tools

EPIC Cadence

Microsoft Office Suite

Internet Explorer

Job description

Department

02409 WFBMG University Group Practice: Winston Salem Professional Park - Surgery: Plastic and Reconstruction

Status

Full time

Benefits Eligible

Yes

Hours Per Week

40

Schedule Details/Additional Information

Monday - Friday, 8am to 5pm
AHWFB Plastic Surgery Clinic
1450 Professional Park
Winston-Salem, NC

Pay Range

$21.85 - $32.80

Education/Experience

• High school diploma or equivalent and three years of experience working in a role within a customer service, fast paced environment with high volume of either calls or in-person requests; or an equivalent combination of education and experience

Reports To

• Supervisor, Clinic Registration

LICENSURE, CERTIFICATION, And/or REGISTRATION

• N/A

Essential Functions

• Interview patients in-person and/or by phone to obtain all required information for hospital records and billing systems. Pre-registers all scheduled patients for admission, partial hospitalization, and outpatient services according to department policies and procedures.
• Verify insurance coverage and obtains authorization for all services requiring pre-certification.
• Process internal and out-going referrals, as needed, per department procedures
• Perform clerical functions as needed, including answering phones, taking messages, chart processing, faxing and scanning.
• Collect and process upfront deposits or set-up payment arrangements, as required.
• Screen patient for Medicaid, Affordable care Act or hospital sponsored financial program and provides appropriate documentation and referral.
• Assist other team members where necessary
• Adhere to department policies and procedures related to verification of eligibility, benefits, pre-authorization requirements, available payment options, financial counseling and other identified financial clearance related duties
• Complete assigned registration functions within multi-specialty clinic and/or emergency department, which may include claim edit work queues, pre-certifications and authorizations.
• The Patient Services Representative III is expected to sequence multiple physician visits and complete registration activities within multiple registration platforms
• Assists team with escalated issues, trains other team members as needed and is a subject matter expert.
• Participate in departmental performance improvement initiatives
• Other duties as assigned or requested by Supervisor or Manager, such as acting as back up in other departments
• Understand and maintain operations knowledge of Medicare and other state and federal government payor compliance requirements for the population served.

Skills & Qualifications

• EPIC Cadence experience preferred.
• Expert knowledge of patient access services and the overall effect on the revenue cycle.
• A thorough understanding of commercial and government insurance plans, payer networks, government resources and medical terminology.
• Understand and maintain operations knowledge of Medicare and other state and federal government payor compliance requirements for the population served.
• Demonstrated proficiency in communicating effectively with a customer and simplifying complex information.
• Demonstrated ability of critical thinking skills and adhering to compliance protocols.
• Demonstrated ability to handle escalated issues, train/mentor other team members and viewed as a subject matter expert.
• Ability to navigate Internet Explorer and Microsoft Office Suite of applications.
• Experience working in a role that requires prioritization of multiple critical priorities while ensuring quality and achievement of performance metrics.
• Demonstrated ability to meet or exceed performance metrics.
• Ability to handle sensitive information and maintain HIPAA compliance.

Work Environment

• Clean, indoor environment
• Minimal travel to clinic locations where assistance is needed

Physical Requirements

Amount of time spent performing the following activities:
0%35%65%tototo35%65%100%N/AActivityXStandingXWalkingXSittingXBendingXReaching with armsXFinger and hand dexterityXTalkingXHearingXSeeingLifting, carrying, pushing and or pulling:X20 lbs. maximumX50 lbs. maximumX100 lbs. maximum

Our Commitment To You

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits And More

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

The Patient Services Representative II facilitates all components of patient registration by accurately and efficiently handling the day-to-day operations relating to a patient's scheduled appointment. This includes obtaining all necessary demographic and financial information to ensure that the most accurate patient data is obtained and populated into the patient record. This role is also responsible for creating a positive patient experience and representing Advocate Health Wake Forest Baptist and partner organizations in a professional manner.