Patient Service Representative; PSR - Per Diem - Oncology

Overview

Completes patient order confirmations and modifications for item changes occurring after initial order ticket printing to begin revenue recognition and billing processes.

• Reviews all paperwork submitted with equipment set up packets to ensure all forms are complete, signed and dated appropriately.
• Addresses safety issues documented by drivers with appropriate correspondence to patients, physicians or management (e.g., patient smoking in the home with oxygen, incorrect storage of oxygen tanks).
• Processes service maintenance tickets and resets the schedule for future service and maintenance of rental equipment.
• Maintains knowledge of Medicare, Medicaid, HMO, Managed Care, PHO's and Advocate contract procedures and guidelines.
• Verifies current and appropriate authorizations for all managed care clients for supplies and purchased items.
• Identifies, investigates and verifies sources of reimbursement.
• Performs duties with computerized resources and data entry programs involving proper processing and qualifying of patients with HME/RT needs (e.g., OnBase, Fastrack, Carenet, ERMA and Care Connection).
• Completes daily updates by running the Confirmed Orders for Billing Report to identify and correct errors in order entry.

• Completes Direct Bill entry for supply closet items dispensed at off-site Advocate locations.
• Obtains payable diagnosis codes for items dispensed, using Care Connection visit information or as provided on the delivery transaction form.
• Reviews billing system to determine if the patient has an existing account or creates a new account by entering demographic and insurance information.
• Completes insurance eligibility checks within the billing system for payers supported by the system (e.g., BCBS, Medicare, Medicaid, HMO).
• Enters charges through Direct Billing entry.
• Completes monthly bulk billing to hospital cost centers for Direct Bill items not billed to insurance due to the payer being out-of-network with AHCP.

• Works weekly Open Orders Report and investigates reasons for delays in confirmation and revenue collection according to predefined processes.
• Confirms or deletes open orders after thorough investigation and confirmation that service was provided.
• Completes daily patient record retention and archive processes.

• Prepares documents received during the confirmation process for scanning and indexing into the electronic medical record by removing staples and repairing tears according to predefined instructions.
• Operates and monitors scanning/imaging equipment.
• Reviews output copies to ensure continuing quality of printed images; informs management or IS Department if resolution issues cannot be corrected.
• Indexes scanned documents by accurately selecting proper patient, document type and other descriptors.
• Manages storage and destruction of scanned documents per predefined instructions.

• Prepares and works various reports to maintain accurate account information and status.
• Works monthly discharge reports to inactivate accounts with no active rentals and no activity in over one year.
• Works monthly Medicare Continued Use reports for documentation of patients’ use per Medicare guidelines.
• Follows up on lost/stolen equipment by sending letters to patients and facilities when equipment cannot be retrieved.

• Provides customer service support to internal and external customers by resolving delivery, equipment, documentation and/or reimbursement issues with appropriate parties.
• Responds to customer equipment questions and refers to appropriate distribution associate and follows up to ensure resolution.
• Works with Intake and Distribution to answer questions concerning customer deliveries.
• Offers backup phone support for all AHCP departments, and assists with walk-in patients.

• Other duties as assigned by manager.
• Runs, collects and tabulates data and submits selected reports such as the Daily Order Report.

• High School Diploma
• 3-4 years office experience.
• Understanding of third party payors, including Medicare, Medicaid and private insurance companies.
• Knowledge of medical terminology preferred.
• Home care experience preferred.

• Strong Data Entry ability
• Strong Organization Skills
• Strong Detail Orientation
• Strong Customer Service Skills
• Able to work independently with minimal supervision

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.