Patient Services Representative I - AHWFB Ophthalmology High Point

Advocate Health; High Point (NC); On-site; USD 21,000 - 30,000; Full time

Job summary

Advocate Health in High Point, NC is seeking a patient access specialist to greet patients, verify demographics, and handle registration and insurance verification with accuracy and courtesy.

The role emphasizes financial clearance, collecting balances, and directing patients to financial counseling when needed. Strong organization, basic knowledge of Medicare/HIPAA/EMTALA, and proficiency in Microsoft Office are required.

Qualifications

• High school diploma or GED required.
• Experience in patient access, scheduling, registration or financial clearance preferred.
• Knowledge of Medicare, Medicaid and third-party payer requirements helpful.
• Ability to handle sensitive information and maintain confidentiality.

Responsibilities

• Greets patients arriving for appointments and manages flow.
• Verifies and updates patient demographics and insurance information.
• Completes registration for walk-in patients; verifies changes.
• Verifies insurance benefits and collects out-of-pocket liability.
• Follows financial clearance policy for non-urgent services when needed.
• Identifies patients needing financial assistance and refers to Financial Counselor.
• Performs visit closures, schedules follow-ups, and provides documents.
• Keeps knowledge of payer requirements and pre-authorization rules up to date.
• Suggests process improvements to management.
• Maintains productivity and accuracy targets in daily work.
• Maintains professional relations with patients and staff.

Skills

Medicare knowledge

HIPAA knowledge

EMTALA rules

Customer service

Data entry

Microsoft Office

Communication skills

Problem solving

Education

High school diploma or GED

Tools

ADT software

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

EDUCATION/EXPERIENCE:

High school diploma or GED required. Patient access (scheduling, registration and financial clearance), insurance verification, billing or certified medical assistant experience preferred.

REPORTS TO:

Supervisor or Manager

LICENSURE, CERTIFICATION, and/or REGISTRATION:

N/A

ESSENTIAL FUNCTIONS:

1. Greets patients arriving for their appointments. Monitors patient flow to ensure patients are cared for in the most efficient and courteous manner.

2. Ensures all patient demographic and insurance information is complete and accurate

3. Completes the registration process on walk-in patients, verifies and / or updates patient demographic and insurance information if changes or additions have occurred

4. Verifies insurance benefits. Obtains, calculates and collects the patient's out of pocket financial liability. Requests and collects past due and present balances or estimates due

5. Follows the Financial Clearance policy for non-urgent patient services if financial clearance has not been completed or authorization has not been obtained, when appropriate

6. Identifies patients in need of financial assistance and refers patients to Financial Counselor

7. Performs visit closure, including but not limited to checking out patients, scheduling follow-up appointment(s), collecting additional patient responsibility (when applicable) and providing patient with appropriate documents.

8. Maintains knowledge of and reference materials of the following: Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.

9. Proactively communicates issues involving customer service and process improvement opportunities to management

10. Meets productivity requirements to ensure excellent service is provided to customers

11. Meets or exceeds performance expectations of 98% accuracy rate and established department productivity measurements.

12. Maintains excellent public relations with patients, families, and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information

SKILLS & QUALIFICATIONS:

• Ability to identify and understand issues and problems.
• Examines data and draws logical conclusions based on information available Knowledge and ability to articulate explanations of Medicare, HIPAA, and EMTALA rules and regulations and comply with updates on insurance pre-certification requirements
• Mathematical aptitude, effective oral and written communication skills and critical thinking skills
• Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral, pre-certification and authorization processes.
• Ability to speak effectively to customers or employees of the organization; presents a pleasant, professional demeanor and image during telephone conversation
• Ability to handle sensitive and confidential information according to internal policies
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
• Experience with Microsoft Outlook, Word and Excel and ADT software Ability to write routine correspondence, calculate figures and amounts such as discounts and percentages
• Must be able to work with minimal supervision, to problem solve in a high profile and high stress area and interact positively with all internal and external customers while possessing the ability to determine priority of work

WORK ENVIRONMENT:

Exposed to a normal office environment. Must be able to sit the majority of the workday. Occasionally lifts up to 10 lbs. Operates all equipment necessary to perform the job