POSITION OBJECTIVE/SUMMARY:
The Patient Service Representative (PSR) reports to the Revenue Management Analyst of the Revenue management Division.
This position is responsible for completing the financial clearance process within MyAvatar for Inpatient services AIP and CIP.
MINIMUM QUALIFICATIONS REQUIRED FOR THIS POSITION:
Minimum Education: An Associates Degree or equivalent Degree in Health Information Management or three years of experience in carrying out government agency billing
Must be able to read and write English.
Ability to relate to patients, through familiarity with medical terminology and triage procedure.
Must believe in health care with dignity for all.
Demonstrated ability to build and maintain good customer rapport.
Proficient with Microsoft Suite and EHR such as My Avatar, Epic, XM, etc.
JOB REQUIREMENTS:
Warmly greets patients as they arrive for treatment.
Identify insurance billing and claims processing assistance.
Collecting all needed information to get claim billed out.
Must be able to articulate information in a manner that patients, guarantors and family members understand so that they know what to expect and will have an understanding of their financial responsibilities.
Responsible for finalizing registration, benefits verification and assignment, certification, referral management, co-pay collections and medical necessity check, verifying eligibility and corresponding benefit levels, coordinating referrals and obtaining treatment authorizations.
Work with clinical staff, ancillary departments, insurance Payer’s and other external sources to assist consumers in obtaining healthcare and financial services.
Ability to navigate Web based web pages and the electronic health record; other preferred skills include understanding of EDI (Electronic Data Interchange), DMH (LA county Department of Mental Health).
Work closely with the Analyst to provide trending denials and feed back to support process to be built.
Must be able to analyze billing reports with in the My Avatar system to track claim processing and denial management.
Conducts pretreatment duties with each Client such as – confirmation of MC Eligibility; confirmation of Kedren’s Open Episode; confirmation of an open Episode at LAC DMH; verification of consumer’s contact information, etc.
Conducts UMDAP for qualifying consumers
Obtains authorization from Payers when necessary, prior to treatment
Answer incoming calls (not processed by the Call Center) to Front-desk and route them to the appropriate staff as needed
Register patients per registration protocols
Creates eChart for newly enrolled patients
Claims billing
Claims denial review and resolution
Promote Kedren’s services by consulting, gathering information, and evaluating patient needs.
Work closely with other department for services offered to ensure smooth patient flow and cut down on waiting time
Explain the services available, payment categories, and billing procedures.
Attend all mandatory programs training such as Medi-Cal, OHC, Medicare, etc.
as required.
Carries out additional duties as necessary in support of Clinical services
Takes initiative, is flexible, has the ability to multi task, ability to work in a fast-paced environment and adapt quickly to changing priorities, autonomous but also comfortable working within a team context.
Ability and willingness to treat all patients with the utmost kindness and consideration in the most trying situations.
Friendly personality with the desire to work with the public.
Ability to handle multi-functions.
Understanding of community based organizations.
Communicate patients’ problems to the appropriate staff.
Ability to relate to the public regardless of ethnic, religious, sexual orientation and economic status.
Maintain regular, consistent, and timely attendance.
Demonstrate a passion and commitment for the Mission and Vincentian Core Values of Kedren.
Create an atmosphere of enthusiasm and energetic commitment and serve as a role model in carrying out the Mission
Strong computer skills including proficiency in Microsoft Office applications as well as the ability to adapt quickly to industry-specific software
All Associates, regardless of position, serve as role models for clients who are served by our agency.
Therefore, each Associate must be emotionally stable at all times, and able to function effectively with children, adolescents and adults who may have mental or behavioral health problems.
The staff must be able to demonstrate appropriate daily behavior, appropriate expression of emotions, as well as appropriate role modeling.
Hostility, aggression or unnecessary or inappropriate physical actions as well as inappropriate emotional expression are not acceptable.
Job Type: Full-time
Schedule:
8 hour shift
Day shift
Monday to Friday
Education:
High school or equivalent (Preferred)
Work Location:
One location
Work Remotely:
No
Work Location: One location