PFS Representative Patient Referrals

JOB SUMMARY

The Patient Financial Services Representative supports the mission of providing quality healthcare to the patients of WhidbeyHealth by performing a variety of duties that support the financial health and well-being of the organization. The PFS Representative may be responsible for coordinating patient referrals and subsequent follow up, verifying insurance and providing financial counseling to assist with self-pay accounts, as well as billing and collection of insurance and self-pay accounts. This position is expected to demonstrate professional behavior, display appropriate conduct and show consideration, respect and patience towards all patients, families, staff and professional affiliates. The PFS Representative follows all federal, state and payer specific regulations and policies pertaining to documentation and billing practices to ensure all work is in compliance with established guidelines.

PRINCIPLE FUNCTIONS includes the following, other duties may be assigned:

• Patient Referrals:

• Coordinates patients through referral and follow-up care by scheduling with appropriate specialists, facilities, agencies and insurance companies.

• Ensures that appropriate and timely follow up is provided to the patient, while documenting all patient referral information in a manner that is clear and understandable by staff.
• Requests appropriate copies of chart notes, laboratory results, radiology images, patient history and disseminates that information to the designated referral sources and monitors progress.
• Provides updates to department staff when there are changes in referral procedures, laws and insurance requirements that would affect the patients' care plan.
• Works as an integral part of the care team, coordinating needs and patient progress with providers and other designated staff members, to ensure a cohesive and seamless referral experience for the patient and patient's family.
• Completes all forms according to department and governmental guidelines.
• Scans all documentation into the patient's electronic medical record.
• Maintains a comprehensive filing system that clearly identifies and updates all forms used in the referral process. Provides timely creation, updates, and corrections to forms as needed.

• May be required to provide back up to the Patient Registrar or HIM Technician on as needed basis to support department or clinic functions.

• Insurance Verifier:

• Contacts insurance companies on preadmissions and admissions, verifying eligibility and benefits for patients.

• Notifies the Financial Advocate and/or service department or clinic of patients who do not have appropriate referrals and authorizations in place.
• Documents contact person name, eligibility, benefits, referrals, authorization, and any other pertinent information in notes.
• Obtains patient signatures on messages from Medicare and Tricare.
• Maintains insurance notebook on different payer requirements.
• Acts as an insurance resource to other departments and provides training in the use of eligibility resources.
• Reviews department schedules and identifies patients not yet pre-admitted for pending services. Contacts and interviews patients by phone that have not had services within the past 90 days, obtaining demographic and insurance information.

• May be required to provide back up to the Patient Registrar or Financial Advocate on an as needed basis to support department functions.

• Financial Advocate:

• Interviews and provides financial counseling to all patients regarding patient balances.

• Arranges for the resolutions of patient liabilities through valid financial arrangements.
• Assists and advises patient in obtaining alternative financial resources in order to meet their obligation including