Outpatient Service Representative

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Under the general supervision of, but according to established policies and procedures, the incumbent performs various administrative duties to expedite each patient’s visit for clinical care. These duties include preparation of patient records; registration and pre‑registration activities; problem resolution; appointment scheduling; and, co‑payment preparation and collection. In addition, ancillary duties performed provide tracking and status of follow‑up care as it pertains to specific diagnostic coding, billing/payment resolution, and generation of system reports, which reflect scheduling activities.

Brown University Health employees are expected to successfully role–model the organization’s values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:
Instill Trust and Value Differences Patient and Community Focus and Collaborate.

• Schedules patients using the hospital’s scheduling system. This includes establishing the appointment type, specific provider clinic, and appointment time. Schedules follow‑up appointments using the online scheduling system. May schedule appointments for patients who need lab work, diagnostic imaging or referral to other medical providers. Refers technical/clinical inquiries to appropriate personnel. Utilizes the online billing system to enter diagnosis/service codes from encounter sheets, accurately entering the appropriate code in the hospital’s billing system.
• Completes pre‑registration and registration process using the online billing system. Verifies demographic data, insurance authorization information, co‑pays and physician. Collects co‑payments and provides patients with receipts. Produces registration cards using the online system and card embosser. Photocopies front and back of insurance card. Confirms patient eligibility with insurance carriers and obtains visit authorizations as necessary. Provides mature, quality customer service to patients, their families and/or their representatives.
• Mails informational material to new patients in advance of scheduled appointments. As necessary, contacts agencies outside the Hospital to obtain pertinent patient information and to coordinate clinic/treatment programs. Contacts third‑party payors to obtain required pre‑authorizations in accordance with established policies.
• Acts as an outpatient center receptionist. Makes telephone calls to patients as appointment reminders. Answers incoming calls. Returns phone calls to patients, physician offices and other medical providers such as laboratory and radiology facilities. Greets arriving patients and verifies pertinent information and physician using the online billing system. Orients patients to the specific outpatient center as a hospital‑based service. Interacts effectively with patients and their family members.
• Handles coding/billing within parameters as outlined in the department guideline. Using the online billing system enters diagnosis codes/service codes from encounter sheets. Verifies the appropriateness of the diagnostic code prior to entering in the billing system. Interacts with patients and Patient Financial Services to resolve billing issues, including denials. Appropriately refers patients to patient advocate for financial counseling.
• Obtains and organizes medical records for use by physicians and nurses. Ensures patient’s file is complete prior to treatment/clinic visit including appropriate records, lab test results and x‑rays. Evaluates file prior to scheduled visit and follows up with other hospital departments to obtain missing data.
• Prints reports using both the online scheduling and billing systems.
• Performs all duties in accordance with RIH’s mission, the defined role of ambulatory care, and defined administrative/clerical…