Summary

SUMMARY:

Under general supervision, the Patient Services Representative (PSR) provides a specialized clerical support service to the various clinic registration units and screen patients for possible eligibility into various financial programs. Specially trained to perform the patient registration and less complex enrollment of eligible patients into various financial assistance programs. PSRs are also a part of the ambulatory care team and support the day to day functions of the clinic practice and team-based care. The PSRs may be required to work in alternate locations as necessary. Program enrollment responsibilities include but are not necessarily limited to the following:), Childhood Health and Disability Program (CHDP), Charity (AHS’s Charity Program), Presumptive Eligibility (PE), and Cancer Detection Program (CDP). Performs related duties as required.

DUTIES & ESSENTIAL JOB FUNCTIONS:  NOTE: Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1.  Provides patient-centered care that is respectful of, and responsive to, individual patient preferences, needs and values. Provides and promotes excellence in customer service for both internal and external customers.

2.  Collaborates with patients and other healthcare providers to deliver coordinated, high quality care.

3.  Registration and Pre-registration for Ambulatory Care Services; Interview patients to obtain necessary information for billing purposes, financial screening of patients and process documents to establish source of payment, and preparation of registration packets and patient visit. Appointment scheduling in person, and/or on the phone with excellent customer service.

4.  Advise patient and/or guarantor of financial obligations; collection and process payments, co-payments and pre-payments for services. Verify insurance program eligibility and coverage for Ambulatory Care Services.

5.  Interprets laws and regulations of Federal, State, and County programs and advises patient of eligibility requirements, as well as their rights and obligations in receiving financial services. Assist patient in completing applications and forms, as necessary, and reviews for accuracy and completion.

6.  Enter registration and billing information into computer application system following specific guidelines and instructions; retrieve data and prepare variety of reports related to patient census, patient insurance, and financial status.

7.  Distribute, complete, and collect forms and documents for Ambulatory Care Services; Provide explanation and education to patients of services and resources available.  Determine enrollment options for eligible patients into various financial assistance programs, and enrollment of health coverage programs as needed.

8.  Maintain records of unit productivity, patient location, registration and discharge.

9.  Inform and advise medical providers of patient’s financial status and maintain open communication with Healthcare providers and staff to ensure timely notification of any health conditions or diagnosis that could qualify the patient for programs to assist the patient(s) with their healthcare costs.

10. Assist and respond to patient inquiries regarding Alameda Health System (AHS) health care services; Inform patients of AHS and Ambulatory Care Services policies and procedures, direct patients to appropriate medical service areas.

11. Referral processing as needed to provide timely, accurate, and quality to care and services. Process and submit required authorization and prior authorization forms with Health Plans or Medical/Provider groups as directed by the referring provider. Generate required correspondence/review notification of patients and providers of authorization determination or any barriers leading to scheduled services such as self-pay, continuity of care, and cancellation of schedule. Advises patient/guarantor of financial obligations.

12. Conduct outreach functions to achieve AHS organizational goals and initiatives

13. Utilize and operate standard office equipment, including but not limited to telephone, computers, fax machines, and AHS applications; Electronic Health Record, Financial Billing and Registration, and On-Line resources; Use of Telephone, E-Mail, and other equipment to provide communication and support to patients and AHS employees.

14. Provide backup and coverage support for Ambulatory Care Services as assigned.

15. Participates in performance improvement/quality control activities.

16. Ability to empathize with vulnerable populations and underserved patients.

17. Perform related duties as assigned.
 

MINIMUM QUALIFICATIONS:
Education: High School diploma or equivalent.

Minimum Experience: Demonstrated use of computer and telephone systems, and general navigation through application systems.

Medical Terminology: Preferred, not required

Bilingual: Preferred, not required

Additional Information

Note:  Must have medical healthcare prior authorization and insurance verification experience.

MINIMUM QUALIFICATIONS:
Education: High School diploma or equivalent.

Minimum Experience: Demonstrated use of computer and telephone systems, and general navigation through application systems.

Medical Terminology: Preferred, not required

Bilingual: Preferred, not required