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Patient Service Representative- Utilization Review

Company: Mary Free Bed Rehabilitation Hospital
Location: Grand Rapids
Posted on: January 25, 2023

Job Description:


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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