<p>Work Schedule: Monday - Thursday: 11am to 7pm & Friday: 9:30am to 5:30m</p> <p>Position Overview:</p> <p>The Patient Services Representative is responsible for handling front office functions. This work is carried out in support of the mission and goals of Ryan Health.</p> <p>Essential Functions:</p> <p>Patient Processing:</p> <ul> <li> <p>Check in patient's visit and create same day visits when necessary.</p> </li><li> <p>Collect copays from insured patients and appropriate fees from uninsured patients, including any outstanding balances.</p> </li><li> <p>Verify insurance coverage using appropriate equipment, and bill patient's insurance for services.</p> </li><li> <p>Direct 3rd Party, private insured patients to Patient Accounts Department.</p> </li><li> <p>Ensure that referrals and authorization for Specialty services are obtained before processing patient's visit.</p> </li><li> <p>Screen patient for Sliding fee eligibility</p> </li><li> <p>Inform eligible patients of assistance available for entitlements, including but not limited to Medicaid plans, Managed Care plans accepted at the Center, ADAP and refer them to appropriate staff.</p> </li><li> <p>Balance patient revenue collected for bank deposit.</p> </li><li> <p>Collect and ensure all patient information is appropriately signed and scanned into the patients' hub.</p> </li><li> <p>Assist the patient when necessary to change PCP by calling insurance plan.</p> </li><li> <p>Use appropriate equipment to capture patient photo when authorized by the patient.</p> </li><li> <p>Update/recertify patient registration information, as necessary, or when patient reports a change, including but not limited to income, insurance, address, telephone, number of dependents, etc.</p> </li><li> <p>Refer patients to appropriate Ryan Health departments and community or social agencies as needed.</p> </li><li> <p>Check-out patients after booking all appointments as per provider instructions.</p> </li><li> <p>Ensure that telephone encounters are processed efficiently and appropriately.</p> </li><li> <p>Book and/or Status referral requests appropriately including but not limited to Diagnostic and procedure orders.</p> </li><li> <p>Schedule and status urgent/STAT/High Risk referrals as per procedure.</p> </li><li> <p>Review practitioner schedules and mark no-show appointments.</p> </li><li> <p>Verify patient address/telephone number for certified mail.</p> </li><li> <p>Consult with provider and/or authorized staff when provider's schedule must be overridden.</p> </li><li> <p>Pose as Greeter when assigned by Supervisor</p> </li></ul> <p>Insurance Processing:</p> <ul> <li> <p>Verify detailed insurance information for all services provided at the Center, including but not limited to Commercial, MLTC and supplemental plans.</p> </li><li> <p>Screen and complete insurance applications for eligible patients</p> </li><li> <p>Process payment plans/bills, when applicable, including but not limited to Itemized bills.</p> </li><li> <p>Process Utilization Thresholds.</p> </li><li> <p>Assist patients with insurance restrictions.</p> </li><li> <p>Maintain and update the insurance verification via electronic medical Record (EMR) system</p> </li><li> <p>Update and maintain information per current procedure.</p> </li><li> <p>Attend trainings and webinars as assigned by Supervisor.</p> </li></ul> <p>Referral Processing:</p> <ul> <li> <p>Ensure the appropriate Specialty Referral Form, if required, has been initiated and that all required information is provided; including the number of visits and expiration date of the referral.</p> </li><li> <p>Fax referral form and supporting documents (i.e. progress note, radiology reports, laboratory results) as attached by the practitioner, to Off-Site specialists via fax.</p> </li><li> <p>Obtain prior authorization for specialty visits, when required by the patient's insurance carrier.</p> </li><li> <p>Schedule appointments to the appropriate off-site specialist as per the practitioner's note, or patient's preference.</p> </li><li> <p>Document the specialty appointment date, time and location in the patient's Electronic Health Record (EHR)</p> </li><li> <p>Maintain assigned referrals in accordance with the Network's referral management policy and procedure.</p> </li><li> <p>Process, monitor, and reconcile Urgent/STAT/High-Risk referrals.</p> </li><li> <p>Ensure appointments for Urgent/STAT/High-Risk referrals are scheduled in accordance with the timeframe specified in the Network's referral processing and tracking policy and procedure.</p> </li><li> <p>Monitor Urgent/STAT/High-Risk specialty appointments to verify patient attended the appointment.</p> </li><li> <p>Obtain consultation reports from specialty providers in order to reconcile and address Urgent/STAT/High-Risk referrals.</p> </li><li> <p>Review monthly report of all Urgent/STAT/High-Risk referrals to track metrics related to the timeliness in which referrals are processed and addressed.</p> </li><li> <p>Responsible for maintaining and updating incoming referrals to ensure that all off-site appointments are scheduled.</p> </li><li> <p>In the patient's EHR, document the status of off-site specialty appointments.</p> </li><li> <p>Contact the patient with appointment information, via the patient's preferred method of contact.</p> </li><li> <p>Print and mail completed referral form to patient.</p> </li><li> <p>Call the patient with appointment information when the appointment date is within five business days or less.</p> </li></ul> <p>Other:</p> <ul> <li> <p>Review billing/global alerts before processing patients.</p> </li><li> <p>Immediately report any problems or unusual occurrences to supervisor.</p> </li><li> <p>Other duties and/or projects as assigned.</p> </li></ul>