N00307 – Patient Services Representative – Lab

Position Overview: Provides superior customer service in identifying patient payment responsibility for uninsured, out of network, or high deductible insurance plans. Following established standard operating procedures and designated tools, the Patient Services Representative (PSR) will determine out of pocket expense for the patient. The PSR informs patients in advance of applicable patient personal responsibility in connection with health insurance reimbursement for laboratory services providing the patient with the necessary details needed to make an informed decision regarding payment for services.

Specific Responsibilities:

• Serves as the primary point of contact between patients, clients, and ordering providers.
• Exhibits exceptional telephone etiquette in a manner consistent with policy and documents necessary information from the patient in order to obtain applicable personal patient responsibility for laboratory service(s) in a timely and accurate manner.
• Contacts payors to obtain details regarding specific laboratory services and plan benefits.
• Collects required documentation from the patients electing to pay for services directly (Self-Pay Election Form).
• Requests payment(s) from patients and records payments in appropriate system(s) using standard operating procedures.
• Obtains electronic signatures for any electronic payments received.
• Sends receipts to patients for paid services.
• Expressly discloses that self-payment will not accrue toward satisfaction of any deductible under patient’s health insurance (unless the health insurance plan states otherwise).
• Prioritizes daily work and accesses volumes to adjust workload and areas of focus as needed.
• Demonstrates world class customer service in accordance with the laboratory revenue cycle department service excellence standards when responding to patient or client verbal and written correspondence.
• Documents all responses and actions taken in the billing revenue cycle management system.
• Exhibits strong communication skills and positive attitude with internal (team members, other departments, and leadership) and external customers (patients, clients, insurance companies, vendors, and employers). Defuses volatile situations in a calm, objective, and tactful manner. Directs customer complaints to management for immediate response if unable to resolve.
• Maintains thorough knowledge of third-party eligibility and benefit inquiry tools and applications, requirements, and regulatory guidelines.
• Meets or exceeds departmental productivity standards on a consistent basis.
• Informs the leader of consistent issues as they occur and make recommendations to improve departmental quality outcomes.
• Assists management in the development and implementation of new policies and procedures.
• Coordinates activity with internal and external customers and serves as primary contact person for issues relating to the Billing Policy.
• Selects priorities and organizes work and time to meet them in order of importance.
• Performs office related support tasks, clerical duties and/or general office duties which may include creating reports, typing, filing, faxing, answering telephones, taking messages, and making copies.
• Participates as a team member by performing additional assignments not directly related to the job description when workload requires and as directed by management.
• Projects/Maintains a positive attitude and conducts his/herself in a manner conducive to improving the working environment and morale and supporting leadership initiatives.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines and regulations.
• Demonstrates attention to detail, initiative, and judgment.
• Exhibits poise, tact, and compassion dealing with patients and clients.
• Performs other duties and special projects as assigned.

Education and Experience:

• High school diploma or equivalent GED.
• A comprehensive understanding of insurance requirements and regulations, contract benefits, credit and collection procedures, as well as a familiarity of medical terminology is required. This level of experience would generally be acquired through two years’ experience in medical billing.
• Must be able to handle a fast-paced environment in a confident, professional manner. Must be a self-motivator, possessing a high level of judgment skills and initiative, along with ability to prioritize and coordinate several tasks simultaneously, while retaining a confident, knowledgeable, and helpful demeanor.
• Ability to listen compassionately demonstrating effective problem-solving and critical-thinking techniques to areas of concern to patients and employees without appearing judgmental is essential.
• Work requires interpersonal skills necessary for making patient and third-party payer contacts. Must be able to work with interruption by co-workers or other internal customers needing assistance with patient accounts.
• Work requires advanced reading, writing and oral communication skills as well as the knowledge to perform mathematical calculations.
• Knowledge of insurance including Medicare, Medicaid, HMO, PPO, Commercial insurance verification and familiarity of ICD-10 coding.
• Proficiency in Microsoft office suite.

Competencies:

Customer Service: Demonstrates concern for meeting internal and external customers’ needs in a manner that provides satisfaction for the customer within the resources that can be made available.

Integrity: Upholds personal and professional ethics and values, considering the values of GENETWORx and respecting the culture, beliefs, and abilities of individuals.

Ability to effectively perform in a fast-paced environment: Demonstrates the ability to respond to multiple difficult requests with a consistently high level of accuracy.

Work Environment: May work in a variety of environments including professional offices, clinics, hospitals, or out-patient facilities.

Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus.

Travel: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected