Patient Services Representative

Patient Services Representative

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.

Essential Functions:

• Check in patient's visit and create same day visits when necessary.
• Collect copays from insured patients and appropriate fees from uninsured patients, including any outstanding balances.
• Verify insurance coverage using appropriate equipment, and bill patient's insurance for services.
• Direct 3rd Party, private insured patients to Patient Accounts Department.
• Ensure that referrals and authorization for Specialty services are obtained before processing patient's visit.
• Screen patient for Sliding fee eligibility.
• 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.
• Balance patient revenue collected for bank deposit.
• Collect and ensure all patient information is appropriately signed and scanned into the patients' hub.
• Assist the patient when necessary to change PCP by calling insurance plan.
• Use appropriate equipment to capture patient photo when authorized by the patient.

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.

Refer patients to appropriate Ryan Health departments and community or social agencies as needed.

Check-out patients after booking all appointments as per provider instructions.

Ensure that telephone encounters are processed efficiently and appropriately.

Book and/or Status referral requests appropriately including but not limited to Diagnostic and procedure orders.

Schedule and status urgent/STAT/High Risk referrals as per procedure.

Review practitioner schedules and mark no-show appointments.

Verify patient address/telephone number for certified mail.

Consult with provider and/or authorized staff when provider's schedule must be overridden.

Pose as Greeter when assigned by Supervisor.

Verify detailed insurance information for all services provided at the Center, including but not limited to Commercial, MLTC and supplemental plans.

Screen and complete insurance applications for eligible patients.

Process payment plans/bills, when applicable, including but not limited to Itemized bills.

Process Utilization Thresholds.

Assist patients with insurance restrictions.

Maintain and update the insurance verification via electronic medical Record (EMR) system.

Update and maintain information per current procedure.

Attend trainings and webinars as assigned by Supervisor.

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.

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.

Obtain prior authorization for specialty visits, when required by the patient's insurance carrier.

Schedule appointments to the appropriate off-site specialist as per the practitioner's note, or patient's preference.

Document the specialty appointment date, time and location in the patient's Electronic Health Record (EHR)

Maintain assigned referrals in accordance with the Network's referral management policy and procedure.

Process, monitor, and reconcile Urgent/STAT/High-Risk referrals.

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.

Monitor Urgent/STAT/High-Risk specialty appointments to verify patient attended the appointment.

Obtain consultation reports from specialty providers in order to reconcile and address Urgent/STAT/High-Risk referrals.

Review monthly report of all Urgent/STAT/High-Risk referrals to track metrics related to the timeliness in which referrals are processed and addressed.

Responsible for maintaining and updating incoming referrals to ensure that all off-site appointments are scheduled.

In the patient's EHR, document the status of off-site specialty appointments.

Contact the patient with appointment information, via the patient's preferred method of contact.

Print and mail completed referral form to patient.

Call the patient with appointment information when the appointment date is within five business days or less.

Review billing/global alerts before processing patients.

Immediately report any problems or unusual occurrences to supervisor.

Other duties and/or projects as assigned.