Surgery Center Service Representative

Summary

The Surgery Center Service Representative is responsible for scheduling and registering outpatient diagnostic testing and/or surgical procedures, supporting the general operation of the department, and remaining flexible at all times. This position provides services for pre-registration, payer authorization, registration services, pre and point of service collections, medical necessity checking and financial counseling, referring those patients to appropriate sources for follow up as needed. Customer service is an essential element of the position, as the employee will be responsible for assisting physicians, patients, visitors, and hospital staff with their needs as they relate to the functions of the department.

Essential Duties and Responsibilities

These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.

Registration

• Manages registrations for patients for the CRSCVB; meets patient access scorecard standards by registering patients in <= 10 minutes maintaining a wait time of <= 10 minutes when applicable.

• Interviews and accurately collects patient information and demographics; meets patient access scorecard standards by meeting accuracy rate as defined in annual goals and ensuring accuracy in medical record selection.

• Uses knowledge to verify, review, and coordinate benefits on behalf of patients; meets Patient Access Scorecard expectations for insurance verification rate.

• Manages payments at point of service, conducts cash receipting, and posts payments; point of service collection expectations are on the patient access scorecard.

• Assists patients with financial clearance of accounts by communicating financial responsibility through estimates, setting up payment plans, and/or providing referrals to financial counselors.

• Manages accounts in order to meet Patient Access Scorecard standards of productivity.

• In addition to daily account authorization reviews; identifies high risk admissions/registrations and obtains complete necessary authorizations and notifications of admissions from patients; meets patient access scorecard standards by reducing denial rates.

• Assists with training of new staff as well as shares departmental knowledge and provides assistive training with teammates.

• Manages scanning for the patients' medical record as required.

• Compiles, reviews, and manages weekly and monthly electronic reports as assigned by manager; makes financial edits preventing billing of accounts, corrects addresses or other demographic data for patients, or manages errors for other staff in order to successfully clear accounts.

• Provides courteous service to all stakeholders (patients, patient families, teammates, other department staff, etc.) by resolving stakeholder problems, responding to inquiries, and following-up in order to develop and strengthen customer relationships and maintain effective interdepartmental communication. Level of service and demonstrated patient commitment are connected to the patient access scorecard, the patient satisfaction scorecard and patient access department policies.

• Complies with governmental regulations in reference to healthcare, billing, the Health Insurance Portability and Accountability Act (HIPAA) and patient access department policies and procedures.

• Demonstrates knowledge of ICD coding requirements and other billing rules.

• Promotes continuous process and quality improvement processes by sharing and providing ideas and solutions to teammates, supervisors, and attending staff meetings; maintains educational requirements, and participates in new learning opportunities.

• Explores learning opportunities for professional development and growth of self, patient access department and CRMC by participating in professional organizations, participating in interdepartmental committees and projects, and conducting teach-backs to staff.

• Demonstrates an awareness of appropriate confidentiality rules and regulations and acts accordingly.

• Actively participates in service recovery and customer service activities to ensure a superior customer contact.

• Other duties as assigned.

Scheduling

• Obtain detailed information to include: type of surgery, equipment needed, anesthesia requested, and preoperative testing required by surgeon.

• Coordinate schedules with the Operating Room to ensure no lapses of productivity for center or the surgeon.

• Maintain accountability for scheduling surgery in an efficient manner to ensure surgeon productivity.

• Coordinate continuity of care with programmatic coordinators.

• Communicate with all coordinators, staff, insurance companies, and physicians regarding changes in schedule and/or patient status.

• Phone triage patients for multiple conditions, and route them to the appropriate program.

• Serve on committees and assist other team members as requested by the supervisor.

• Maintain communication with the supervisor at least once a week to review financial performance targets as well as other projects defined by the Director.

• Enter all surgery scheduling into the practice's management system.

• Attend all required orientations, meetings, and in-services.

• Demonstrate a commitment to flexible work scheduling when necessary to ensure patient care.

Operations/Workflow

• Greet patients and visitors to the Center.

• Answer telephones.

• Update patient information.

• Print face sheets and labels.

• Obtains required signatures on proper paperwork.

• Is knowledgeable of various insurance plans and can explain benefits clearly to a patient.

• Is effective in asking for appropriate co-payments and deductibles; this is demonstrated by a high collection rate.

• Post payments and balance daily batch.

• Is aware of the different opportunities available.

Supervisory Responsibilities

Reports to: CRSCVB Clinical Director

May be provided direction by: Clinical Coordinator or Surgery Center Service Representative Lead

Supervises: None

Responsibilities: Not applicable

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience

Minimum Required Education: High school diploma or equivalent required.

Preferred Education: Knowledge of medical terminology and ICD preferred. Associate degree in a health care field preferred (Health Information Technology, Medical Assistant, etc.)

Experience: Proficient and accurate data entry, typing skills. One year of current hospital or medical office experience required.

Certificates, Licenses, Registrations

Certification as Medical Assistant, Nursing Assistant, Emergency Medical Technician, or Paramedic preferred.

Certified Healthcare Access Associate (CHAA), Certified Professional Coder (CPC) or other HFMA, NAHAM or AAHAM recognized revenue cycle certification required within 12 months in position.