Patient Service Representative – Outpatient Eligibility, Procedural Authorization

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

📋 Description

• Ensure the accuracy and completeness of patient accounts in accordance with departmental protocols, policies, procedures, and regulatory compliance standards.

• Execute pre-admission, admission, pre-registration, and registration processes.

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

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

• Evaluate insurance coverage and benefits to guarantee timely reimbursement.

• Acquire PACs and necessary authorizations as required.

• Coordinate referrals to Financial Services for patients without insurance and those needing financial counseling.

• Investigate accident-related circumstances to identify the appropriate liability or payment source.

• Schedule and pre-register patients while correcting any demographic and financial information.

• Address and resolve insurance claim rejections and denials.

• Remind patients of outstanding balances, co-pays, coinsurance, and deductibles.

• Assess diagnoses for adherence to Local Medicare Review Policy.

• Clarify billing in accordance with PRMO credit and collection policies.

• Enact collection actions and assist financially responsible individuals in arranging payments.

• Identify third-party sponsorship needs and process patients in line with policy.

• Review insurance policies and third-party sponsorship materials to determine payment sources.

• Notify attending physicians regarding patient financial difficulties.

• Update billing systems to reflect patient insurance status.

• Deliver prompt customer service to internal clients and support departmental coverage.

• Document authorizations and refresh referrals in the billing system.

• Communicate with insurance providers concerning clinical information, coverage, and payment matters.

⛳️ Requirements

• High school education-level proficiency in basic grammar and mathematical concepts.

• Preferred completion of some postsecondary education.

• Additional training or practical knowledge in related fields is beneficial.

• 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 abilities.

• Capability to analyze data, manage multiple tasks, and work autonomously.

• Skill in building and maintaining professional, service-oriented relationships with patients, physicians, co-workers, and supervisors.

• Capacity to comprehend and adhere to policies and procedures.

• No formal degrees, licenses, or certifications are necessary.

🏝️ Benefits

• [Insert benefit details here]

• [Insert additional benefit details here]