ABOUT NCH
NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.
NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.
JOB SUMMARY
The Lead Patient Service Representative position provides a vital link in the chain of Quality of Care; the Team Leader supports the clinic and Practice Manager and ensures proper training and guidance to front desk staff.
ESSENTIAL DUTIES AND RESPONSIBILITIES
· Handles all referrals as well as Mayo Referrals for NCH Physicians Group and NCH Healthcare System.
· Actively participates in data collection, demonstrates advanced knowledge base and clinical skills.
· Release of NCH records and ensures proper HIPAA forms are utilized.
· Serves as a liaison between NCH and Mayo Clinic.
· Ensures coordination of calls with questions regarding Mayo and NCH.
· Facilitates requests for records from NCH Physician Group and provides the requesting records from Mayo Clinic.
· Enters eConsults requests into Mayo Portal from NCHPH referrals.
· Prepares records, pathology slides, and images for download to Mayo Clinic portal.
· Provides Physicians with the report or results from Mayo.
· Maintains quality control and satisfaction.
· Ensures timely access to services through Mayo Portal.
· Informs Director and/or Manager of any situation that may need additional involvement.
· Assumes responsibility for managing office if Practice Manager is out of the office.
· Triage incoming calls and route them appropriately utilizing good customer skills. Demonstrates knowledge of phone system with the ability to use call forward, call transfer, voice mail, etc.
· Obtain required personal information necessary to identify all new and existing patients and the correct demographic and preliminary financial information to enable the creation of new patient medical records and the pre-processing of required authorizations / pre-certifications before the appointed visit.
· Prioritize all insurance coverage – primary / secondary / tertiary etc. Enter properly into demographic record.
· Accurately identifies patients using appropriate search methods (DOB, SSN, etc.) to identify.
· Conduct all required authorizations / pre-certifications for patient visits.
· Copies insurance cards and scans into Centricity. Obtain and photocopy all pertinent insurance information, other healthcare, or financial assistance program documents, driver’s license, etc.
· Verifies patient information on file is accurate and updated as per company standards; updates patient data when insurance, address, or other information has changed. Understands when to correct data or create new file.
· Verify patient registration profiles each time patient comes for a visit. Edit patient registration profiles when necessary.
· Obtain all consents for treatment, including forms for the release of medical information and patient’s acceptance of financial responsibility for all services rendered, when applicable.
· Completes required Medicare questionnaires (ABN Forms) for appropriate patients and tests under Medicare guidelines.
· Accurately and completely processes physician’s referrals and orders and enters the tests into NextGen; should be well versed with NG templates and ordering.
· Maintain patient clinical forms (i.e.: prescriptions, laboratory requisitions, etc.) for patient pick-up.
· Ensures respective patient medical record information, all collected forms and photocopied documentation, are placed in the patient chart or NextGen/EMR in the proper location.
· Schedule appropriate new and follow-up medical/surgical appointments and radiological testing procedures for respective physician sites, based on the patient’s specific needs.
· Announce scheduled and non-scheduled (if appropriate) patients to the clinical staff.
· Confirm and remind patients of scheduled appointments in accordance with the clinic’s procedures.
· Give patients standardized preliminary clinical instructions and directions in preparation for a scheduled office visit, radiological test, or procedure as needed.
· Collection and deposit of all required and mandatory insurance co-payments and deductibles according to specific protocols (ie: time of service collection policy).
· Monitor patient waiting time and relay information regarding delays to patients and family members.
· Ensures benefits & eligibility has been verified for all scheduled patients.
· Accurately enters charges for all services performed.
· Accurately enters payment information for each payment collected.
· Produces appropriate reports to reconcile charges and payments with data entered into Centricity.
· Prepares daily close report detailing reconciliation, prepares bank deposit & submits daily close report to accounting for reconciliation with bank.
· Fields questions by both physicians and patients regarding codes, charges, etc. PSR II understands when questions require further explanation by Practice Manager or Biller.
· Perform CLIA waived testing (glucose,).
· Centrifuge, label and assign specimens to workstations for subsequent analysis
· Maintain inventory of supplies, reorder and stock supplies of assigned area.
· Responsible for obtaining a signature on the Medicare ABN if assigned to patient reception area.
· Responsible for sending specimens to reference laboratories or shipping of specimens to other facilities.
· Responsible for collecting viable and appropriate specimens from patients being studied, verify tests on the requisition.
· Record appropriate collection information on the specimens (including patient name, date and time of collection, and lab assistant’s initials).
· Confer with patients to obtain information for laboratory records, explain procedures, allay fears and elicit cooperation.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
· Minimum of High School or GED required.
· Minimum of 1 year experience in healthcare customer service required.
· Office supervisory experience required.
· Patient service representative experience required.
· Familiar with basic medical terminology and medical terminology associated with the specialty of the clinic.
· Intermediate computer knowledge: Uses Microsoft Word, Excel, Outlook, and Windows.
