Patient Service Representative- Utilization Review
Company: Mary Free Bed Rehabilitation Hospital
Location: Grand Rapids
Posted on: January 25, 2023
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Job Description:
Summary
Greet, provide information, and respond to the needs of patients,
families, staff, and other visitors with services or resources for
a program specific multi-discipline department. Interact in a
customer focused manner during referral processing. Provide office
support for all Scheduling and Patient Financial Services staff.
Work cooperatively with other departments and outpatient
staff/leadership to assure financial reimbursement for outpatient
services. Knowledgeable of payer regulations, as it relates to
his/her area of billing responsibility to ensure compliance with
billing regulations
Essential Job Responsibilities:
+ Working knowledge of the Utilization review (UR) process of
reviewing an episode of care. The review confirms that the
insurance company will provide appropriate financial coverage for
medical services.
+ Knowledge on prior authorization process. This allow payers,
particularly health insurance companies, to manage the cost of
health care benefits by assessing its appropriateness before it is
provided using evidence-based criteria or guidelines.
+ Working knowledge of ICD-10-CM and CPT coding classification
systems.
+ The complete utilization review process consists of
precertification, continued stay review, and transition of
care.
+ Accurately collect and analyze all required demographic,
insurance/financial, and clinical data elements necessary to
pre-register and register all types of patients
+ Coordinate/schedule initial evaluation and subsequent patient
appointments for multi-disciplines based on patient needs
+ Manage calls from insurance/care managers to coordinate multi
discipline care for patients
+ Collect any expected charge for service provided and complete
timely posting of cash collections, accepting and generating
appropriate receipts for monies and credit card payments received;
provide financial guidance to achieve a mutually acceptable
resolution of the expected self-pay balance including options of
payment and charity care
+ Receive and properly respond to telephone, electronic, or
face-to-face inquiries from patients or their legal
representatives
+ Perform all other appropriate activities as directed and as
necessary to meet the patient's needs and to achieve expected
departmental and organizational outcomes
+ Provide various other responsibilities and clerical/therapist
support as delegated by Manager
Essential Job Qualifications (Knowledge, Education, and Training
Requirements)
+ Associates Degree or equivalent business classes/experience
+ Computer experience with high accuracy level of data entry.
+ Excellent telephone and customer service skills.
+ Outstanding organizational, interpersonal, communication, and
overall customer service skills.
+ Ability to perform in a high paced environment with a positive
attitude and interact with professional staff in an appropriate
manner.
+ Physical Demands: Able to exert up to 10 pounds of force
occasionally (up to 1/3 of the time).
+ Able to lift, carry, push, pull, up to 10 pounds occasionally;
able to sit for the majority of the time, nut may involve brief
periods of time involving walking or standing; able to use keyboard
frequently (1/3 to 2/3 of the time)
Other Preferred Job Qualifications:
+ Bachelor's Degree in a health-related field
+ Minimum 12-18 months' work experience in healthcare with
scheduling and/or PFS related job duties.
+ Knowledge of medical terminology and clinical rehabilitation.
Customer Service Responsibilities:
Demonstrate excellent customer service and standards of behaviors
as well as encourages, coaches and monitors the same in team
members. This individual should consistently promote teamwork and
direct communication with co-workers and deal discretely and
sensitively with confidential information
Commitment to Diversity, Equity and Inclusion
Embrace Diversity, Equity and Inclusion, by:
+ Treating everyone with dignity and respect
+ Opening more doors to opportunities for underrepresented
cultures
+ Growing talent and people
+ Evaluating and eliminating disparities
+ Taking action against injustices, bias and racism
+ Honoring our differences and how to collaborate
+ Educating staff, patients and the communities we care for
+ Restoring Hope and Freedom, together
Responsibilities in Quality Improvement:
Contribute by identifying problems and seeking solutions. Promote
patient/family satisfaction where possible; participate in
departmental efforts to monitor and report customer service.
Mary Free Bed is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard
to race, color, religion, gender, national origin, age, genetic
information, veteran status, disability or other legally protected
characteristic.
Keywords: Mary Free Bed Rehabilitation Hospital, Grand Rapids , Patient Service Representative- Utilization Review, Sales , Grand Rapids, Michigan
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