Patient Service Rep Details

Patient Service Rep

Valley Medical Center - Renton, WA

Employment Type : Full-Time

Job Title: Patient Service Rep
Req: 2022-0734
Location: Highlands Primary Care
Department: Renton Highland Clinic
Shift:
Type: Full Time
FTE: 1
Hours:
City State: Renton, WA

Job Description:

VALLEY MEDICAL CENTER

Job Description

Clinic Network

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE: Patient Service Representative

ROLE: See criteria for Administrative Partner for generic job duties

AREA OF ASSIGNMENT: Outpatient Clinic

RESPONSIBLE TO: Clinic Manager

Prerequisites:

High School Graduate or equivalent (G.E.D.) preferred.

Demonstrates basic skills in keyboarding (35 wpm) and using a personal computer in Windows 2000 or XP environment.

Able to communicate effectively in oral and written form in English language.

Evidence of excellent communication skills both oral and written including the ability to spell accurately and write legibly.

Excellent customer service skills.

Knowledge of medical terminology and abbreviations and can spell and understand commonly used terms preferred.

Minimum of 2 years of experience in a reception role, or 1 year in a physician's office.

Float Pool:

1. Has adequate transportation to travel to clinics and VMC campus as necessary.

General Qualifications:

Demonstrated ability to function effectively and interact positively with patients, peers and providers at all times.

Demonstrated ability to access, analyze and apply concepts associated with protocol, policy and guidelines.

Demonstrated understanding of agency compliance standards.

Possess excellent customer service skills:

Acknowledges and positively greets each person within 3 seconds of entering

the reception area.

Ability to communicate and work effectively with the physical and emotional

development of all age groups.

Neat and well-groomed appearance, business professional.

Demonstrated ability to maintain a calm demeanor at all times.

Demonstrated ability to function effectively in an environment where it is necessary to perform several tasks simultaneously, and where interruptions are frequent.

Demonstrated ability to successfully manage telephone interactions.

Demonstrated ability to speak, spell and utilize appropriate grammar and sentence structure.

Demonstrated ability to successfully utilize varying computer tools and software packages:

a. Utilize multiple monitors in facilitation of workflow management

b. Scanning and electronic faxing capabilities

c. Electronic Medical Records

d. Business practice management system

e. Preparation and printing of fee slips

f. Preparation of patient chart

TYPICAL PHYSICAL/MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS:

Generic Job Functions: See generic job description for Administrative Partner.

Unique Job Functions:

Telephone Management:

In order to serve the patient's needs successfully on the phone a PSR needs to listen well and think quickly in order to execute the patient's request. It's important to be patient, and keep the tone of your voice positive and kind. Good organization is key to navigating your way through the various computer programs while trying to locate information for the patient. Calls are continuously arriving in the call queue; the PSR is required to work quickly, while still giving the patient enough time to voice their questions and concerns. PSR's strive to utilize first call resolve. If not, then the PSR will send a message to an MA/facilitator for assistance. When taking messages the PSR gathers as much pertinent information as possible to help the MA/provider turn around requests as quickly as possible. If patients call in with urgent/possible emergent symptoms the PSR, utilizing organization guidelines/protocol will determine if they need to be triaged to a nurse, or referred to an Urgent Care or ER. The PSR's on phones manage the providers schedule in order to ensure that each appointment is allocated per appropriate network approved slots.

1. Demonstrated ability to successfully manage telephone interactions

2. Utilize appropriate tone, be pleasant and calm at all times

3. Listen to information provided by the patient

4. Document per template requirements, gather pertinent information

5. Successfully navigate through multiple software systems

6. Complete calls on average within 1 minute and 45 seconds to 2 minutes

7. Utilize first call resolve

8. Appoints patient according to patient requests and/or schedule limitations

9. Coordinates communication and information with other departments

Appointment Making/Registration/Check-in and Payment Processing

A positive attitude, good listening skills, and patience are essential when working the front check in desk successfully. Multi tasking is a must in order to be successful at the front office position. To check in patients efficiently, it takes someone who can prioritize and make a decision quickly on what can be done now and what can be done later. This ensures that the patients are not waiting in line for longer than necessary and provider exam rooms are kept full at all possible times. PSR's are responsible for handling confidential patient information, so focus and attention to detail are vital for this job. A PSR must verify the name and date of birth with the physical patient on each interaction and upon dispensing any and all documentation with patient related information.

As a representative of healthcare a pleasant smile, a professional demeanor and good personal hygiene go a long way in impressing the patients into continuing their health care with us. Being attentive and responding quickly to the patient's needs and questions makes them feel validated, and confident about their own healthcare. An efficient PSR knows the importance of good communication with the back office regarding appointments on the day list to ensure a smooth transition for the MA's and providers throughout the day. PSR's must ensure that insurances are loaded correctly to make the billing process as smooth as possible. The PSR is also responsible for accurately collecting and recording copays/deposits. Correct billing instills confidence in the patient and helps build a positive experience for them when they choose us for their healthcare needs.

Appointment Making:

1. Prepares and maintains appointment timetables for all providers, including physicians, physician assistants, nurse practitioners, RNs, and other patient care services.

2. Make appointments for outpatient services as requested. Cancels and reschedules appointments as necessary.

4. Arranges for specific patient needs for the time of the appointment, including interpreters, wheelchairs, etc.

5. Screens appointment calls for emergencies (911) and urgent requests go to appropriate team member as necessary.

6. Maintains and works lists for patients needing appointments when patient management system is down. Give the patient the option of leaving name and number, or calling back at a later time.

7. Prints, copies and distributes next day or future schedules as requested.

Registration (Patient Management System):

Verifies and updates the following information each time an appointment is made:

Address, city, state, zip
Day and evening phone numbers
Insurance, including group number
- Reviews the appointment screen for financial/clinical and other flags and refers patient to patient financial services when appropriate.
- Add new account and subscriber information as identified.
- Determine if visit is for an accident or injury, or other type of billable service (i.e., private pay, third party).
- Reviews required fields in the business information management system to assure that minimum data set information is current and up to date at each patient visit.
- Verifies insurance eligibility with the insurance company (via web) as required

Registration - Check In:

Checks patients in for their appointments.

Verifies whether or not patient address, phone number, employment, or insurance information has changed since the appointment was made.

Directs or assists patients in completing appropriate paperwork.

Generates labels and prepares chart for visit or service.

Directs patient to location to wait or receive services, including lab work or x-rays.

Provides information and supplies as necessary.

Responsible for the efficient processing of patients through new patient and established patient registration.

Keeps patient informed of delays in being seen

Payment Processing:

Identifies and collects co-payments for all outpatient services.

Performs daily cash reconciliation and reporting.

Receives and directs other payments coming into the facility.

Responds to questions/issues regarding patient billing.

Collects appropriate paperwork for the visit.

Able to give information regarding the clinic and its financial policies.

MEDICAL RECORDS: SCANNING/ELECTRONIC FAXING

As a scanner you are responsible for ordering charts from archives, managing the clinic worklist by sending charts out to various clinics whom have requested them, scanning from charts for patients that are coming in for appointments which consists of documents designated per network guidelines. In addition the scanner is also responsible for scanning the incoming mail and managing incoming fax's. As needed the scanner is also asked to be a back up phone person for overflow calls. The skills associated with the scanner position are detail oriented, ability to multitask, being able to prioritize what needs to be scanned and assigned to providers first such as lab results, radiology exams, and refill requests. You should also be comfortable in identifying what an incoming document is such as consults, hospital records, transfer records, labs, and pathology and to be able to appropriately assign these documents under the correct section in patient's electronic chart. It is also essential to have time management skills to ensure that priority documents get assigned to patients PCP when they arrive at the office.

Name, date of birth and naming convention is verified to the Electronic Medical Record prior to scanning.

All information is filed in the correct section of the Electronic Medical Record

All incoming documents are analyzed based on priority. High priority information is scanned first into the electronic medical record daily.

All scanning is sorted, initiated and completed daily.

CHART PREP

Chart prep responsibilities include prepping all scheduled appointments for the next day and any add on's for same day appointments. The chart prep person must look up each patient appointment to ensure the patient has an active EMR chart, and if not pull and prep the chart for the scanner to ensure the pick list is scanned into the EMR chart before the provider appointment. As part of chart prep the PSR makes sure each appointment is prepped with labels, medication list, and any forms needed for the visit (examples include CPE questionaire,PHQ-9, face sheet, VFC status forms, etc.) Chart prep is also responsible for making sure all charts in storage at iron mountain are requested by the scanner to ensure the provider has the 2007 or older chart available to review at the appointment and that the pick list is scanned prior to visit. Chart prep also serves as back up for the front desk during lunches and during peak phone hours to help keep our abandonment rates low and decrease patient wait times. Chart prep requires the PSR to multi-task and be aware of the clinic flow at all times to help assist in any area within the clinic that may need coverage, be detail oriented and efficient to facilitate all appointments are properly prepped for each appointment. This helps to ensure the provider and MA has everything required to spend as much time with each patient and make sure their needs are met.

Ensures all patient appointments are prepped in a timely and accurate manner.

Maintains attentiveness to continuous updates and "add-on's" to the Day List.

Reviews the appointment screen for financial/clinical and other flags and refers patient to patient financial services when appropriate.

FACILITATOR/BACK OFFICE DUTIES

It's essential to maintain a calm demeanor to manage multiple tasks while in the back office as a PSR facilitator. Messages from patients, orders from providers, and faxes are coming in throughout the day at a fast rate so it is imperative to be checking each system to ensure a smooth process. As a PSR in the back, your job is to multitask, prioritize, organize and facilitate workflow for the provider and MA. Having this skill set will aid in accomplishing smooth team nursing for the MA's. A well rounded PSR should be able to instill confidence in the provider by following through on their requests and continuing an exceptional patient care experience. The following are some of the main duties of a facilitator: participate in huddles with providers and MA's to anticipate needs/orders/procedures for the day, view daily schedule throughout the day to track when patients arrive in order to communicate/assign to an MA as needed, read, investigate and forward messages to appropriate provider (if needed), contact patient when messages have been answered and record message in Electronic Medical Record, call pharmacies to call in prescriptions that have been approved in Electronic Medical Record or refax through rightfax, facilitate care management calls if necessary, expedite written orders from provider (no verbal orders of any kind), fax or mail paperwork to pharmacies, other medical centers and patients and ensure all paperwork is signed off by appropriate provider in a timely manner.

1. Manages messaging and order workflow.

2. Organizes and allocates orders in a timely fashion

3. Researches and responds to messages in a timely fashion.

4. Acts as liaison between the PSR, MA and Provider.

REFERRALS

As the referral PSR you are sent physician orders in electronic medical record for patients that are being referred out to either a specialist or to have a procedure (i.e. MRI, CT Scan). The PSR is then required to verify if that patient's insurance plan requires a referral or prior authorization and if so the PSR will contact the insurance company either online or by telephone to request the referral/prior auth. Once the PSR determines if a prior authorization is required or not then you update the referral/order in electronic medical record. If no referral/prior auth is required then you can update the order with that information, your name, and then complete the order in electronic medical record. If a referral/prior auth is required then you request that from the insurance company and then update the order with the auth#, effective dates and your name. If the request has to be reviewed by the insurance company then you may be required to provide clinicals (chart notes, labs, diagnostic testing results, CPT/DX codes) along with your request and fax the information to the appropriate fax for that insurance company. If this process is required then the order is changed to sent status in electronic medical record until the approval or denial is received from the insurance company. The PSR will have to hold the paper fax request in the pending file folder until a decision is made and follow up with the insurance company until they reach a decision then update the order in electronic medical record. When a referral/prior auth is received the order in electronic medical record is updated with the Auth#, effective dates, your name and then the order is completed.

Facilitates communication between the clinic and insurance company.

Manages the tracking of referrals requiring pre-authorization and all Diagnostic Imaging.

Follows up with patients who completed orders. Facilitates communication between patient and provider on incomplete orders.

Other:

Responds to patients' questions and investigates and communicates answers as appropriate.

Receives, distributes, and responds to mail for work area.

Monitor office supplies and equipment, keeping person responsible for ordering updated.

Performs procedures for closing office.

Float Pool Addendum:

Able and willing to travel from one clinic to another within the VMC network on a regular basis, including same day travel.

Job Qualifications: