PATIENT SERVICES REPRESENTATIVE (Authorizations, Verification & Referrals))

The Patient Services Representative provides support for patients, providers, and patient services departments. The representative will assist with and be responsible for duties that include, but not limited to, insurance verification, prior authorizations for procedures and medications, coordinating incoming and outgoing referrals and assist with all aspects of AR/Billing. Please note that this position is 100% on-site in our central support office in Plano. 

Responsibilities/Duties:

• Obtain benefit verification by utilizing Athena electronic eligibility or by contacting the actual insurance carriers. Contact insurance carriers to obtain authorizations for diagnostic ancillary services.
• Submit patient referrals to outside resources (i.e. cardiology, radiology.)
• Submit authorization requests for medications; obtain approvals, denials, and work through appeals. Send patient medical records to outside entities per company policies in a timely manner.
• Request patient medical records from outside entities per company policies in a timely manner 
• Receive incoming faxes, sort and distribute to appropriate departments.
• Answer questions from patients regarding account balances. 
• Document and maintain records on each open claim.
• Perform necessary follow-up to ensure proper payment is received. 
• Identify and resolve billing issues.
• Follow-up on report status of past Insurance and patient accounts
• Perform various collection actions including contacting patients by phone, correcting and resubmitting claims. Work daily insurance correspondence as needed.
• Answer questions from patients, co-workers, and insurance companies. 
• Any other duties as assigned.

Job Specifications:

• Must be able to provide professional, responsive, and positive customer service.
• Must be able to verify insurance eligibility for Psychiatry, Neurology and Primary Care Providers. 
• Ability to sit for long periods of time working at a desk and accessing a variety of systems.
• Accuracy with attention to detail.
• Ability to manage time and meet goals and deadlines.
• Ability to work both independently and/or as part of a team in a fast-paced environment. 
• Strong analytical and problem-solving skills.
• Well organized; ability to prioritize multiple projects and deadlines and be able to multi-task. 
• Ability to work under pressure.
• Good customer service skills including sound sensitivity judgement and courteous phone manners. 
• High energy: productive work habits, flexible and adaptable to change.
• Experience with computer programs.

Job Requirements:

• High School or equivalent
• 1 - 4 years' experience obtaining insurance verification and authorizations 
• 1 - 4 years' experience with medical accounts receivable
• Knowledge of medical coding and claims

High School or equivalent

1 - 4 years' experience obtaining insurance verification and authorizations 

1 - 4 years' experience with medical accounts receivable

Knowledge of medical coding and claims

PI284505081