Patient Services Representative

EA Health

San Diego,CA


Essential Functions:* Facilitates incoming calls from patients in order to quickly address questions and resolve claim concerns. This may also include updating demographic information, researching account transaction history, identifying potential coding problems and following up with insurance companies.* Documents all communication appropriately for every account level interaction.* Collects and processes payments from patients. Offer discounts to encourage immediate resolution of claim balance, per policy. Negotiate and set patient payment plans as necessary based on company guidelines.* Accurately research and verify insurance eligibility when a guarantor/patient requests that the balance due be billed to an additional insurance payer. Suspends patient workflow when appropriate, while balance discrepancies, disputes and insurance problems are addressed.* Reviews patient registration, insurance, and third party payments in the medical billing system; including a thorough knowledge and understanding of medical EOBs, patient deductibles and co- pays, and insurance or third party correspondence, contractual payments and adjustments.* Must maintain 95% quality rate based on audit criteria. Achieves goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements. Average Handle Time of 5.5 minutes or less.* Ability to handle multiple priorities at one time, ability to work independently with minimum of supervision and ability to manage and prioritize work queues and paperwork accurately under pressure of Client deadlines.* Participates in staff meetings, trainings, and conference calls as requested and/or required.* Maintains strict patient and provider confidentiality in compliance with all federal, state, and hospital laws and guidelines for release of information.* Reliable, consistent attendance is a requirement and essential function of this position.* Perform other duties as may be assigned.Competencies:* High School Diploma or GED, College degree preferred.* At least two years of experience in same/related field.* Strong verbal, written, and negotiation skills are required to deal with patients issues.* Extensive knowledge on use of email, search engine, Internet; ability to effectively use payer websites and payment gateway; knowledge and use of Microsoft Products: Outlook, Word, Excel. Preferred experience with various billing systems, such as Raintree and Lytec.Work Environment:This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.Physical Demands:* The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.* The employee is required to sit in front of a computer throughout the work day. The employee will infrequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision and working with two monitors.Position Type/Expected Hours of Work:EA Healths normal business hours are 7:00 am to 5:00 pm., Monday through Friday. Some flexibility in hours may be allowed, but the employee must be available during the core work hours of 8:00 to 5:00 p.m. and must work a minimum of 37.5 hours each week to maintain full-time status. Occasional evening and weekend work may be required as job duties demand.Travel:There is little to no travel for this position.Other Duties:Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Other duties may change with reasonable notice.

Go Back