Patient Service Representative - Case Management

Patient Service Representative Case Management

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Patient Service Representative Case Management

This post is also available in :

Scripps Memorial Hospital La Jolla has been one of Southern Californias premier medical centers for more than 90 years. It was the first in San Diego to be designated a Magnet Hospital by the American Nursing Association.

In 2018, Scripps Memorial Hospital La Jolla was ranked No. 1 by U.S. News & World Report for the San Diego region and among the best in the nation in seven specialties.

With 444 licensed beds, we offer a wide range of clinical, surgical and specialty services, and are consistently recognized for quality patient care.

The Scripps Health team is dedicated to making a positive, measurable difference in the health of individuals we serve.

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Location : 9888 GENESEE AVE, La Jolla, CA Job Description Requirements Job Description Job Description

At Scripps Health, you will experience the pride, support, and respect of an organization that has been repeatedly recognized as one of the nations Top 100 Places to Work.

Youll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if youre open to change, go ahead and unlock your potential.

Join the Case Management team at Scripps Memorial Hospital La Jolla as a Patient Service Representative. In this important role, your primary responsibilities will be sending referrals to post-acute providers and placement, coordinating transportation services, creating durable medical equipment referrals and delivering equipment to patients' rooms that is already in house, calling and waiting for insurance authorizations and notification to insurance of stability for patient transfer, sending CMS medical records for discharge appeals, and sending Medi-Cal admin day referrals.

General PSR duties may include :

• Interacting with patients, payers and providers to gather information necessary for accurate registration including assigning of appropriate medical record number, scheduling, and referral / authorization, point of service payment collection, document collection and arrival / check-in functions
• Responding to customer billing and payment inquires as needed.
• Effectively managing the patient check-in and check-out process from start to finish, which includes identification verification;
• updating or confirming demographic and insurance information on every patient; ensuring appropriate forms are provided, signed and witnessed at the time of the patient visit;

collecting patient payment responsibility and accurately preparing end of day reporting or payment reconciliation as needed.

• Escalating billing inquiries as needed.
• Accurately scheduling patient appointments. Successful scheduling includes, but is not limited to, exhibiting proficiency in appointment scheduling procedures, accurate documentation and routing of messages, scheduling and confirming appointments according to practice guidelines, entering appropriate insurance, performing key user duties with minimal errors.
• May be responsible for initiating and validating referrals / authorizations.
• Regularly displaying a proactive approach to customer service by listening to the patient, taking ownership of solutions and being able to accurately identify the need to involve leadership in order to resolve concerns.

This is a benefitted Full Time (32 hours per week), Day Shift position with a varied schedule and eight hour shifts which include some weekends and holidays, located at Scripps Memorial La Jolla.

As a condition of employment, Scripps Health requires all employees to provide proof of full COVID-19 vaccination or agree to vaccination at the point of hire or submit a written request on the appropriate Scripps form for an exception based on a medical reason, disability or sincerely-held religious belief, practice or observance with supporting documentation.

Proof of vaccination must be submitted at the pre-employment physical. Alternatively, if an applicant is not fully vaccinated at the time of offer acceptance, they should reach out to their Recruitment Coordinator as possible to obtain instructions on where to go to obtain vaccination or to request forms to request an exception based on a valid medical reason, disability or sincerely-held religious belief, practice or observance with supporting documentation.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity / expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.*

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Requirements Requirements

Required Qualifications :

• Must be able to demonstrate proficiency of computer applications, excellent mathematical skills and ability to handle monies.
• Excellent communication and customer service skills.
• Strong organizational and analytical skills; innovative with ability to identify and solve problems.

Preferred Qualifications :

• 1 year of experience in a customer service or healthcare / medical office environment preferred.
• Able to adapt, prioritize and meet deadlines.
• Knowledge of medical terminology, commercial and government health insurance and billing guidelines, ACA requirements, understanding of DRG's, Medical ICD9 / ICD10 codes and CPT / HCPC Codes and Modifiers.

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Ensures nursing practice reflects established standards of care and practice and a culture that promotes patient safety. Under the general direction of the Patient Care Manager, shares leadership responsibilities for the nursing unit, including managing daily staffing plans.

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Assesses and improves the patient care process for the assigned population along the continuum of care, serving as an expert clinical resource for ensuring quality of care and customer satisfaction.

Develops competencies for care line staff and may facilitate staff education.

• Home to 5 hospitals, 30+ outpatient centers and hundreds of affiliated physician offices
• Known for our compassionate, collaborative culture
• The only San Diego-based company to make Fortune magazines 100 Best Places to Work
• Consistently ranked by U.S. News & World Report among the nations best
• At the forefront of clinical research and education, with three highly respected graduate medical education programs and one of the top teaching hospitals in the nation
21 days ago