Memorial Health System

  • Patient Resource Specialist

    Job Locations US-IL-Lincoln
    ID
    2020-3353
    Category
    Clerical, Administrative and Business Support
    Position Type
    PRN
  • Overview

    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.

    Qualifications

    Education:
    • High School diploma or GED equivalent required.

     

    Licensure/Certification/Registry:
    • None

     

    Experience:
    • 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.

     

    Other Knowledge/Skills/Abilities:
    • 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).

    Responsibilities

    1. Assist customers or others regarding patient account issues. Educate patients/others regarding the resolution of billing, private pay options, collection efforts, coordination of benefits, third party and governmental payment criteria, insurance coverage, payments, and denials. Serve as a liaison between external resources, colleagues, and patients. 

     

    1. Demonstrate superior patient relations and interpersonal skills; demonstrate an appropriate level of mental and emotional tolerance and even temperament when dealing with colleagues, patients and general public, using tact, sensitivity and sound judgment; promote a positive work environment and contribute to the overall team efforts of the department and organization.

     

    1. Coordinate accurate patient data collection to verify insurance eligibility and determine financial obligation, which may include collection of copayments and deductibles.

     

    1. Effectively negotiate with patients and families to explain, collect, and record patient payments and/or deposits, within electronic payment and patient accounting systems.  Process and reconcile cash, check and credit card transactions or bank loans as appropriate. Maintain the accuracy and security of the cash drawer and all cash equivalents.  Prepare bank deposits for pickup.

     

    1. Effectively triage, document, and initiate referrals of patients for financial assistance to MHS Patient Financial Services, completing necessary paperwork/application.

     

    1. Reviews and combines multiple financial accounts for individual patients. Explains available payment options and establishes appropriate payment plans with patients/ responsible parties, per departmental policies and procedures. 

     

    1. Research and resolve complex issues associated with patient accounts. As applicable, identify, document, and report problematic trends to management.

     

    1. Accurately record all customer visits, ensuring proactive discussion of all the patient’s accounts. Note, log, and batch accounts according to established departmental procedures.

     

    1. Accurately and thoroughly document the pertinent collection activity performed. Complete/send daily account payment reconciliation reports to appropriate teams within MHS Finance Department.

     

    1. Identify, prioritize, and resolve problematic accounts. Perform appropriate review/investigation/verification of patient eligibility for possible payer sources and/or financial assistance.

     

    1. Coordinates with MHS Patient Financial Services, Patient Access, Case Management, Scheduling, and clinical departments to ensure consistent financial documentation across the enterprise, and an interdisciplinary approach to patient and organizational needs.

     

    1. Build strong working relationships with assigned business units, hospital departments or provider offices. Identify trends in payment issues and communicate with internal and external customers as appropriate to educate and correct problems.

     

    1. Responsible for completing all steps of pre-registration/registration; verifies patient identity and demographic information through the patient interview. Identifies and captures appropriate health insurance information and benefit eligibility.  Provides Advance Directive information and distributes required patient information. 

     

    1. Orients and cross-trains others within assigned area of responsibility as directed and defined by management. Understands the functionality of all computer systems related to job function. May assist other areas within the unit or department, as necessary, during times of special needs or staff absences.

     

    1. Coordinate patient or family requests for records with HIM.

     

    1. Performs other related work as required or requested.

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