Under general and direct supervision by the Director, Compliance and Medical Staff Affairs and indirect supervision by the Team Lead, the Patient Resource Specialist is responsible for creating an excellent impression of ALMH’s resources to patients, families and other external customers over the phone or in person. They work collaboratively with patients, providers, colleagues, and insurance companies to ensure that patient needs are met. The Patient Resource Specialist will coordinate and participate in a variety of duties assigned with the pre-visit process including patient identification, pre-registration, pre-authorization, and patient appointment scheduling. The Patient Resource Specialist provides payment options, collects patient balances due as appropriate, and effectively triages, documents, and initiates referrals of patients for financial assistance, per the Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act, and established Patient Financial Services procedures. The Patient Resource Specialist is responsible for maintaining knowledge of Joint Commission standards, Patient Rights and Responsibilities, HIPAA compliance, as well as departmental/Health System policies and procedures.
• High School diploma or GED equivalent required.
• Two (2) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Previous experience in Patient Financial Services is highly desirable.
• 3+ years of customer service experience required. Medical terminology, medical office registration or billing experience strongly preferred.
• CPSI/Evident systems experience preferred.
• Knowledge of medical terminology, Current Procedural Terminology (CPT,) HCPCS, CCI Edits, diagnosis (ICD-10 CM) coding and procedural (ICD-10 PCS) coding, Revenue Codes, as well as UB-04 and Explanation of Benefits (EOB) interpretation.
• Working knowledge of computers is required, with the ability to enter and retrieve data, and electronically notate patient accounting software and other required applications/systems.
• Must demonstrate detail orientation, critical thinking, and problem solving ability.
• Must demonstrate excellent oral and written communication and customer service skills, with ability to maintain a calm and professional demeanor in high stress situations.
• Must demonstrate ability to work successfully with internal and external customers.
• Demonstrated ability to remain flexible, and consistently exercise sound judgment and initiative in very stressful situations. Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
• Must demonstrate ability to educate, persuade, and negotiate effectively with patients and families.
• Familiarity with state and federal regulations, insurance requirements/guidelines, and hospital, department and Joint Commission policies and procedures (obtained within 1 year of hire and maintained throughout employment).