Patient Service Representative - Prior Authorization (Home Health)

Patient Service Representative - Prior Authorization is responsible for discussing insurance coverage, including usual and customary charges, Medicare and Medical Assistance availability, reimbursement options available for services, educating patients regarding the Clinic's billing and credit policies, work with patient's insurance carrier to verify benefits coverage for treatment, and discuss any credit concerns regarding a past due account and make special arrangements if necessary to assure payment will be made in a timely manner.

Job Relationships

Reports to Operations Manager or Director of the service line

Principal Responsibilities

• Verify coverage and benefits prior to treatment.
• Secure prior-approval and pre-authorizations.
• Maintain proficiency with insurance and billing issues and serve as a resource to providers and staff.
• Provide a positive impression to patients about the Clinic's billing department.
• Enter/edit patient insurance coverage/demographic information when necessary.
• Answer questions that patients may have in regard to insurance coverage and other billing issues.
• Respond to patient's verbal and written requests in a timely fashion.
• Maintain statistics.
• Maintain proficiency with insurance and billing issues by participating in Patient Accounting meetings and training sessions as appropriate.
• Must be empathetic, yet responsive to patients while adhering to Patient Accounting billing practices and guidelines.
• Provide coverage at other Springfield Clinic locations as assigned.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education/Experience

• High School graduate or GED required.
• Minimum two to three (2-3) years experience in medical billing and insurance preferred.

Knowledge, Skills and Abilities

• Ability to handle multiple tasks and prioritize in a fast-paced environment required.
• Computer skills, including Microsoft Office, preferred.
• Strong verbal communication and listening skills are required.
• Knowledge of the computer systems with emphasis on registration and insurance screens.
• Knowledge of Medicare, medical assistance and other third party payors.
• Ability to work with patients of all ages in a courteous and professional manner. Must be empathetic, yet responsive to Patient Accounting billing policies and guidelines.
• Ability to tactfully work with patients with past due accounts.
• Ability to meet quality and performance guidelines and work with patients in a courteous and professional manner.
• Must have the ability to maintain composure under stress.
• Manual dexterity required for use of telephone headset, calculator and computer keyboard.

Working Environment

• Work in office environment.
• Use of telephone required.
• Involves frequent contact with staff and the public.
• Requires siting for long periods of time.
• Some bending and stretching required.

PHI/Privacy Level

HIPAA1