Patient Service Representative

The Patient Service Representative acts as the primary liaison for the clinic, facilitating the complete patient encounter lifecycle from initial scheduling and registration through financial processing and check-out. This role serves the department by ensuring operational efficiency and data accuracy, including payment collection. Ultimately, this position supports the College’s mission by providing seamless administrative support and high-quality customer service.

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.