Patient Service Representative

Essential Duties and Responsibilities

A. Front Office & Patient Flow

• Customer Service: Serves as the first point of contact, answering phones in a professional manner, greeting all patients upon arrival, and confirming appointment times.
• Patient Flow: Directs patients to appropriate clinical areas to ensure smooth operational activity and monitors the waiting room to maintain safety and cleanliness standards.
• Communication: Explains walk-in and appointment procedures to prospective patients, referral sources, and the general public.
• General Admin: Opens and sorts incoming mail and pulls medical records for telephone inquiries as needed.

B. Scheduling & Registration

• Appointment Management: Accurately schedules new and return patient appointments based on physician or student doctor availability and medical specialty protocols.
• Registration: Obtains, verifies, and records patient demographic and insurance information required by the appointment system.
• Insurance Verification: Verifies financial eligibility for all scheduled patients and obtains necessary authorization based on specific insurance requirements.
• Maintenance: Performs scheduling maintenance as required, coordinates referral appointments, and confirms all appointments 48 hours in advance.

C. Financial & Revenue Cycle

• Collections: Responsible for point-of-service collections, including co-payments, deductibles, non-covered services, and self-pay balances.
• Cash Handling: Receives and processes payments according to cash management policy; balances the cash drawer at the end of every shift/day using the daily balancing proof sheet.

III. Knowledge, Skills, and Abilities

A. Technical Knowledge & Medical Office Skills

• Medical Terminology: Sufficient proficiency in medical terminology to accurately identify and explain medical procedures to patients, third-party payers, and facility personnel.
• Coding & Billing: Knowledge of CPT/CDT and current ICD coding standards (e.g., ICD-10).
• Insurance Proficiency: Sufficient knowledge of insurance plans to correctly interpret patient financial information and assess the need for prior authorizations and referrals.
• Office Procedures: Thorough understanding of general medical office procedures and protocols, including familiarity with substance abuse treatment environments.
• Records Management: Strict adherence to patient confidentiality standards (HIPAA) and release of information protocols; ability to file accurately using numerical and alphabetical systems.
• Technology: Proficiency with standard office hardware (computers, copiers, fax machines) and software applications.

B. Professional Attributes & Communication

• Communication: Excellent oral and written communication skills, with professional and courteous telephone etiquette.
• Customer Service: Ability to interact positively and professionally with the general public, staff, and clients.
• Work Ethic: Skilled at managing multiple priorities and working effectively under pressure in a busy clinical environment.

IV. Minimum Qualifications (Placeholder)

• Education: High School Diploma or GED required. Associate’s degree or relevant certification (e.g., Medical Office Specialist) preferred.
• Experience: One (1) to two (2) years of experience working in a fast-paced medical office, clinic, or hospital setting required.

V. Physical Demands and Working Environment (Placeholder)

• Work is performed primarily in a standard office environment, frequently requiring the use of office equipment.
• Requires prolonged sitting, standing, and walking, as well as lifting and carrying supplies up to 20 pounds.