Patient Service Representative - Oncology

Job Description

The Patient Service Representative - Operations is responsible for discussing insurance coverage, including usual and customary charges, Medicare and Medical Assistance availability, reimbursement options available for services, educating patients regarding the Clinic's billing and credit policies, working with patient’s insurance carrier to verify benefits coverage for treatment, and discussing credit concerns regarding any past‑due account and making special arrangements to assure timely payment.

Reports to the Operations Manager or Director of the service line.

• Verify/secure referrals.
• Verify coverage and benefits prior to treatment.
• Secure prior‑approval and pre‑authorizations.
• Perform review and action of bad debt, collections, and denials.
• Maintain proficiency with insurance and billing issues and serve as a resource to providers and staff.
• Prepare account action worksheets and submit to Patient Accounting for charge corrections.
• Provide a positive impression to patients about the Clinic's billing department.
• Enter or edit patient insurance coverage and demographic information when necessary.
• Inform patients of the Clinic's billing and credit policies.
• Answer questions that patients may have regarding insurance coverage and other billing issues.
• Respond to patients' verbal and written requests in a timely fashion.
• Maintain statistics.
• Maintain proficiency with insurance and billing issues by participating in Patient Accounting meetings and training sessions as appropriate.
• Must be empathetic, yet responsive to patients while adhering to Patient Accounting billing practices and guidelines.
• Provide coverage at other Springfield Clinic locations as assigned.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training and accomplishments required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

• High school graduate or GED required.
• Minimum two to three (2‑3) years of experience in medical billing and insurance preferred.

• Ability to handle multiple tasks and prioritize in a fast‑paced environment required.
• Computer skills, including Microsoft Office, preferred.
• Strong verbal communication and listening skills required.
• Knowledge of computer systems with emphasis on registration and insurance screens.
• Knowledge of Medicare, medical assistance, and other third‑party payors.
• Ability to work with patients of all ages in a courteous and professional manner; must be empathetic yet responsive to Patient Accounting billing policies and guidelines.
• Ability to tactfully work with patients with past‑due accounts.
• Ability to meet quality and performance guidelines while working with patients in a courteous and professional manner.
• Must have the ability to maintain composure under stress.
• Manual dexterity required for use of telephone headset, calculator, and computer keyboard.

• Work in office environment.
• Use of telephone required.
• Involves frequent contact with staff and the public.
• Requires sitting for long periods of time.
• Some bending and stretching required.

HIPAA1