Patient Care Representative

Department: Clinic Administration

Manager Title: Office Manager

FLSA Status: Non-Exempt

Job Summary: Responsible for the operations of the reception area, registering and scheduling of patients, collecting co-pays and money charged for services rendered and handling all patient inquiries.

Essential Duties and Responsibilities:

• Greets all patients, staff, visitors, and vendors in a professional and welcoming manner
• Schedules appointments in order to track billing slips to ensure charge capture occurs
• Prepares for day, reviews Eligibility and Phone report, prepares any new patient charts and/or paperwork at patient presentation

• Performs registration in clinic setting and via telephone to ensure demographic and insurance information is accurate and complete
• Obtains copies of insurance cards, drivers license, authorizations, and referrals and scan or enter them into electronic health record
• Ensures all requirements and fields noted on the Check-In and Check-Out page are satisfied and complete
• Collects co-payments and outstanding balances at Check-In, and time of service balances and estimated balances at Check-Out according to policy
• Reviews and complies with Patient Account Notes and Appointment Notes in electronic health record
• Refers patients to Financial Counselors regarding past due balances, questions and/or resolution that PCRs are unable to answer
• Processes claim creations in electronic health record at Check-Out
• Submits appropriate claims for Real Time Adjudication
• Works Day End Review report and designated Tier-based HOLD Claim Worklist(s) on a daily basis
• Accepts accountability for all Worklists on the dashboard or elsewhere based on assignment
• Answers the telephone directing calls to appropriate areas or takes messages and relays them to the appropriate staff member as necessary
• Informs patient of privacy policies and procedures
• Informs patients of delays in physician schedules, assists with patient comfort while delayed
• Schedules follow-up appointments, creates appointment ticklers in electronic health record, and works associated Worklists relative to both based on assignment
• Creates a Time of Service batch and links it to a deposit batch daily
• Reconciles, balances, and closes each batch /drawer at end of day
• Turns over batches to the designated resource daily
• Covers for other staff in reception, including other office locations
• Processes all releases for medical information ensuring appropriate consents are completed, adhering to PCCs HIPAA and privacy guidelines
• Drive continual quality improvement through participation in organizational quality improvement efforts that may include but are not limited to patient satisfaction, clinical and operational quality improvement initiatives.
• Maintains a neat and orderly work area
• Performs other duties as assigned

Experience/Training:

• High school diploma or equivalent
• 1 - 2 years EMR experience in medical setting preferred
• Constantly communicates with patients, families, and other healthcare providers. Must be able to exchange accurate information in these situations.
• Proficient in MS Office Business Applications to include: Outlook, Word, PowerPoint, and Excel.

Certifications/Licenses:

• None

Physical Demands:

• Must be able to remain in a stationary position 50% of the time.
• Must be able to move around the clinic site 50% of the time.
• Constantly operates a computer, computer printer, copy machine, and telephone.
• Occasionally positions self to maintain exertion of physical strength to move objects of 10 pounds from one level to another.
• Must be able to transport from one site to another.
• Must be able to cover other shifts as necessary.

Other Skills

• Ability to read and write proficiently using the English language.
• Constantly communicates with other healthcare providers. Must be able to exchange accurate information in these situations.
• Follow-through, assume responsibility and use good judgment.
• Maintain professionalism under stressful situations.
• Self-motivated and directed with the ability to prioritize and work efficiently under pressure.
• Ability to understand and follow verbal and written communication.
• Detail oriented with the ability to work with minimal/no supervision.
• Willingness to be part of a team-unit and cooperate in the accomplishment of departmental goals and objectives.
• Effective and creative problem solving.