Patient Services Representative, Pediatric Pulmonology, FT, Days

Prisma Health; Columbia (SC); On-site; USD 35,000 - 55,000; Full time

Job summary

An established healthcare provider is seeking a dedicated front office team member to manage patient interactions and billing processes. This role is essential in ensuring accurate patient registration, handling insurance claims, and maintaining financial agreements. The ideal candidate will possess excellent interpersonal skills and a strong commitment to service. Join a compassionate team where you can make a real difference in patients' lives while contributing to the overall efficiency of healthcare operations. This position offers an opportunity to grow in a supportive environment, with a focus on quality patient care and operational excellence.

Qualifications

• High School diploma or equivalent required; Associate degree preferred.
• No previous experience required; multi-specialty group practice experience preferred.

Responsibilities

• Responsible for patient registration, coding, and billing processes.
• Acts as a liaison between patients and medical staff, ensuring smooth operations.

Skills

Interpersonal Skills

Patient Registration

Insurance Claims Processing

ICD-9 and CPT Coding

Education

High School Diploma

Associate Degree in Technical Specialty

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Incumbents are responsible for aspects of Physician Practice front office management and operation as assigned. May be responsible for some or all front office functions as detailed in the next section.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.

• Responsible for complete and accurate patient registration, pre-certification, charge capture, and accurately coding diagnoses given by physicians. Responsible for posting all payments and balancing with the computer reports at day end. Requires a high level of public contact and excellent interpersonal skills. Arranges for patient pre-payments and enforces financial agreements prior to providing service. Gathers charge information, codes, enters into database, completes billing process, distributes billing information. Files insurance claims and assists patients in completing insurance forms. Processes unpaid accounts by contacting patients and third-party payers.

• Liaison between patient and medical support staff. Greets patients and visitors in a prompt, courteous, and helpful manner. Checks in patients, verifies and updates necessary insurance information in the patient accounting system. Obtains signatures on all forms and documents as required. Assists patients with ambulatory difficulties. Maintains appointment book and follows office scheduling policies. Provides front office phone support as needed and outlined through cross-training program. Screens visitors and responds to routine requests for information. Responsible for gathering, accurately coding, and posting outpatient charges. Processes vouchers and private payments, including updating registration screens based on checks. Researches address verification as needed. Helps to process mail return statements and outgoing statements. Acquires billing information for all doctors for all patients seen in practice. Performs cashiering functions including monitoring and balancing cash drawer daily. Prepares daily cash deposits. Receives payments from patients and issues receipts. Codes and posts payments and maintains required records, reports, and files. Works with patients in securing prepayment sources or financial agreements prior to providing service. Participates with other staff to achieve account resolution. Assists with outpatient coding and error resolution. Processes edits and Customer Service and Collection Requests for resolution within specified time frames. Identifies trends and communicates problems to management. Updates patient account database. Maintains and updates current information on physician schedules. Schedules surgeries, ancillary services, follow-up outpatient appointments, and admissions as requested. Answers questions regarding patient appointments and testing. Assembles patients’ charts for next day visits. Updates profiles on all patients, ensuring completeness and accuracy. Oversees waiting area, coordinates patient movement, reports problems or irregularities.

• Assists patients with questions on insurance claims, obtaining disability insurance benefits, home health care, medical equipment, surgical care, etc. Processes benefit correspondence, signature, and insurance forms to expedite payment of outstanding claims. Assists patients in completing all necessary forms to obtain hospitalization or surgical pre-certification from insurance companies. Follows up with insurance companies ensuring coverage is approved. Posts all actions and maintains permanent record of patient accounts. Answers patient questions and inquiries regarding their accounts. Confirms all workers’ compensation claims with employees. Prepares disability claims in a timely manner. Follows up with insurance companies ensuring claims are paid as directed. Maintains files with referral slips, medical authorizations, and insurance slips.

• Researches all information needed to complete outpatient billing process including getting charge information from physicians. Codes information about procedures performed and diagnoses on charge keys. Enters charge information into online programs. Processes and distributes copies of billings according to clinic policies. Assists with outpatient coding and error resolution. Pulls charts for scheduled appointments in advance. Delivers, transports, sorts, and files returned charts. Picks up lab reports, dictations, X-rays, and correspondence. Checks for misfiled charts and refiles accordingly. Maintains orderly files. Files all medical reports. Purges obsolete records and follows procedures for retention and destruction. Makes up new patient charts. Repairs damaged charts. Assists in locating and filing records. Works with medical staff to route patient charts. Follows medical records policies and procedures.

• Collects payments at time of service for outpatient visits. Reviews accounts via computer to ensure timely payments. Performs collection actions including contacting patients by phone and resubmitting claims. Evaluates patient financial status and establishes payment plans. Reviews accounts for possible assignment to collection agencies. Resolves patient billing complaints. Follows up on accounts until zero balance or they are turned over for collection. Participates in educational activities. Gathers and verifies superbills daily. Enters charge and payment information, verifying accuracy. Prints daily reports, verifies charge entry balancing at day end. Backs up and closes computer files daily. Registers new patients after verifying status. Updates financial information. Maintains confidentiality. Participates in educational activities. Performs related work as required. Maintains professional appearance, demonstrates commitment to service, and upholds office guidelines.

• Performs other duties as assigned.

Supervisory/Management Responsibility

• This is a non-management job that reports to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma. Associate degree in a technical specialty program of at least 18 months preferred.

• Experience - No previous experience required. Multi-specialty group practice setting experience is preferred.

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• Basic understanding of ICD-9 and CPT coding - preferred.

Work Shift

Day (United States of America)