Northern Light Eastern Maine Medical Center
Department: Primary Care - EMMC
Position is located: 925 Union Street
Work Type: Full Time
FTE: 0.9 (36 hours per week)
Work Schedule: Variable
The Patient Service Representative I is a supporting position and is responsible for a variety of activities related to patient in-take and care. The Patient Services Representative I is generally the first point of contact for patients entering the practice. Activities may include but are not limited to greeting and checking in patients, verifying and updating insurance information and confirming other patient information, scheduling patient appointments, answering phones, updating demographic information, processing referrals, payment collection and posting, charge reconciliation, chart preparation and other duties as assigned.
- Communicates Effectively
- Demonstrates effective and courteous Customer, Physician/Practice Staff and other hospital staff communication skills
- Communicates in a way that conveys understanding and respect to a diverse patient and work population
- Answers all calls promptly and courteously
- Responds to and resolves issues promptly through effective communication.
- Uses appropriate chain of command
- Feedback is provided in a constructive manner
- Demonstrates problem solving skills by responding to and resolving issues promptly through effective communication skills
- Maintains adaptability in work schedule to meet patient/departmental needs
- Develops and maintains positive working relationships
- Acts as a resource to coworkers
- Confirms patient identity by using the full name
- Participates in problem solving groups as requested. Attends all practice staff meetings
May serve as a receptionist to patients by:
- Greeting patients, having patient(s) sign appropriate forms/consents.
- Verifying and updating demographic/insurance information on all encounter forms and systems per protocol. Notifying registration of changes if applicable.
- Demonstrating mastery of appropriate practice software and registration tool protocols.
- Scheduling tests, procedures, referral appointments with scheduling center, agencies and/or other provider groups and forwarding order form and/or records to appropriate depart/office. Documenting information in Patient's chart. Processing insurance referral/prior authorization and document this per protocol.
- Retrieving and processing messages per protocol.
- Assists with orientating and training/cross-training of new and established employees as assigned.
- Provides coverage in other areas as needed
- Effectively covers other support positions (e.g. phones, insurance referrals, scheduler) as needed
- Demonstrates mastery of appropriate scheduling and registration protocols, if appropriate
- Takes ownership for determining customers’ needs and offering assistance
- Schedules outpatient testing per orders/referral process, inputs appointment dates and times into patient EMR, if appropriate
- Recognizes problems and offers constructive solutions
- Performs other duties as assigned by practice leadership
- Reviews material submitted by Health Plans and Managed Care Organizations to gain full understanding of benefit coverage and precertification/authorization, if appropriate
- Quality review procedures are followed to ensure accounts are brought to a timely and accurate resolution, if appropriate
- Ability to prioritize and perform multiple duties, simultaneously
- Ability to take ownership of work and follow up on responsibilities
- Speaks, spells, and writes clearly, concisely and to the point
- Consistently follows Patient Identification IDD by using two patient identifiers related to the registration process
- Patient Identification Manager will be alerted if duplication medical record numbers are identified
- Proper name format is consistently followed
- Managed care organizations are correctly identified and selected as part of the registration process, if appropriate
- Timely modifications of registrations are done in order to ensure billing of encounters, if appropriate
- Uses independent judgment when necessary
- Assists Office Manager with patient complaints related to billing invoices, if appropriate
- Appropriately refers patients/staff with issues/concerns to the direct supervisor
- Performs Service Recovery when necessary
- Has 100% of iCare, employee updates and any other in-services meetings and training as assigned
- Maintains documented evidence of continuing education
- Insurance verification and precertification is performed prior to elective inpatient admission to ensure accounts are secured upon admission, if appropriate
- Names, dates, and times of conversations with businesses, insurances, managed care organizations, Utilization Review, and patients are documented, if appropriate
- Insurance verification and precertification is performed on high dollar outpatient areas to ensure reimbursement, if appropriate
- Understands the implication both clinically and financially of registration errors and the impact on the organization, if appropriate
- Referral calls are made to PCP for Managed Care patients, if appropriate
- Correct insurance is identified and selected when appropriate within the registration fields, if appropriate
- Policy numbers are entered correctly into the registration fields, if appropriate
- Ensures that referral authorization numbers are submitted to Patient Account Services in a timely manner and understands the implications if this is not done, if appropriate
- Finishes work on time 95% of the time, avoiding overtime.
- Prepares billing sheets and codes invoices prior to sending to Accounts Payable, if appropriate
- Collects payments (cash, co-payments, cash, checks and other forms of payment for services rendered; reconciles cash drawer/journal per EMMC policy; promptly secures/delivers the cash deposits in the designated EMMC safe or other designated area for transit to the Fiscal Services Department, if appropriate
- Oversees daily audit/cash control, if appropriate
- Promotes services at Northern Light Eastern Maine Medical Center
- Meets continuing education requirements set forth by the practice
- Seeks opportunities for enhancement of skills
- Assists with answering questions and directing practice staff to appropriate resources
- Attends 100% of employee updates.
Competencies and skills:
* 1+ years of relative work experience required.
* Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
* Acts Strategic: Creates effective plans that anticipate future consequences and opportunities and is able to connect the day to day operations to longer-term objectives, shifts in the industry, and system goals.
* Applies Business Acumen: Demonstrates knowledge of current and future trends that impact organizational success. Applies proven practices and business theories to get results that meet financial as well as other business goals. Recognizes opportunities for new services and products and acts accordingly, taking measured risks into consideration. Possesses a thorough knowledge of their field and independently carries out their work in accordance with professional standards of the profession.
* Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
* Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
* Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.
* Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
* Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
* High School Diploma/General Educational Development (GED)
* Potential exposure to abusive and/or aggressive people.
* Work with computers, typing, reading or writing.
* Lifting, moving and loading 20 to 30 pounds.
* Continuous sitting.
* Continuous standing.
* Continuous walking.
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status