Patient Service Representative – Outpatient Eligibility, Procedural Authorization

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Ensure patient accounts are accurately maintained in line with departmental protocols, policies, procedures, and regulatory standards.

• Carry out pre-admission, admission, pre-registration, and registration duties.

• Verify that insurance requirements are fulfilled prior to patient arrival and inform patients of their financial responsibilities.

• Organize payment options and evaluate patients for eligibility for government funding sources.

• Assess insurance coverage and benefits to guarantee prompt reimbursement.

• Secure PACs and authorizations as necessary.

• Assist in referring uninsured patients to Financial Services for financial counseling.

• Investigate accident-related situations to identify the correct liability or payment source.

• Schedule and pre-register patients, correcting any demographic and financial information as needed.

• Address and resolve rejections and denials of insurance claims.

• Reach out to patients regarding outstanding balances, co-pays, coinsurance, and deductibles.

• Review diagnoses for adherence to Local Medicare Review Policy.

• Clarify billing and insurance issues in accordance with PRMO credit and collection guidelines.

• Execute collection actions and support payment arrangements.

• Assess third-party sponsorship requirements and process patients per policy.

• Analyze insurance policies and third-party sponsorship documentation to identify payment sources.

• Notify attending physicians about patients experiencing financial difficulties.

• Update billing systems with the current insurance status of patients.

• Provide prompt customer service to internal customers and support departmental coverage.

• Acquire and record authorizations in the billing system based on insurance contracts and guidelines.

• Input and update referrals.

• Communicate with insurance carriers regarding requests for clinical information and any coverage or payment concerns.

⛳️ Requirements

• High school diploma with knowledge of basic grammar and mathematical principles.

• Preferred: Some postsecondary education.

• Additional training or foundational understanding of related business practices.

• Two to five years of experience in hospital access, physician office settings, or billing and collections, or an equivalent combination of relevant education and/or experience.

• Exceptional oral and written communication skills.

• Proficient in data analysis, capable of multitasking and working independently.

• Ability to cultivate and sustain professional, service-oriented relationships with patients, physicians, colleagues, and supervisors.

• Understanding and adherence to policies and procedures.

• No specific degrees, licenses, or certifications are required.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Retirement savings plans with employer matching.

• Opportunities for professional development and continuing education.

• Paid time off and holiday pay.

• Supportive work environment with a focus on employee well-being.