Medical Patient Service Representative

• Job Type: Full-Time, Temp to Hire
• Schedule: Monday – Friday, 8:00 AM – 4:30 PM
• Pay: $20-22 hourly]
  

Job Summary
The Patient Services Representative (PSR) is responsible for managing patient charts from intake through billing, ensuring accuracy, completeness, and compliance with all payer requirements. This role is critical in minimizing suspended billing, supporting timely reimbursement, and delivering a clear and positive patient financial experience.

The ideal candidate is detail-oriented, comfortable in a high-volume environment, and experienced with insurance verification, prior authorizations, and medical documentation standards.

Key Responsibilities

Patient Chart & Documentation Management

• Review and manage patient charts from initial order through billing completion
• Ensure all documentation is complete, accurate, and compliant prior to billing
• Verify evaluations, prescriptions, physician notes, and clinical documentation
• Confirm measurements, device specifications, and medical necessity

Insurance Verification & Compliance

• Verify and re-verify insurance coverage for dates of service
• Ensure compliance with Medicare, Medicaid, and commercial payer requirements
• Validate physician enrollment (PECOS, Medicaid as applicable)
• Confirm Medicare A/B stay requirements when applicable
• Ensure ABNs are properly completed and signed

Coding, Billing & Authorizations

• Validate HCPCS coding accuracy (quantities, modifiers, diagnoses)
• Ensure pricing aligns with payer fee schedules and patient responsibility
• Manage prior authorizations, pre-determinations, and re-certifications
• Maintain SWOs (LMNs/CMNs), PDAC documentation, and supporting records
• Verify Proof of Delivery (POD) accuracy

Patient Financial Communication

• Educate patients on deductibles, coinsurance, and copays
• Document financial discussions and payment outcomes
• Ensure accurate reflection of patient responsibility in billing systems

Systems & Workflow Management

• Maintain accurate data in patient management and billing systems
• Utilize payer portals and internal tools
• Manage work-in-progress (WIP) to prevent billing delays
• Use system updates to maintain efficient chart flow

Qualifications

• High school diploma required; associate or bachelor’s degree preferred
• 2+ years of experience in medical billing, patient services, or healthcare administration
• Knowledge of Medicare, Medicaid, and commercial insurance processes
• Experience with HCPCS coding, authorizations, and documentation requirements
• Familiarity with DME or orthotics/prosthetics preferred
• Strong attention to detail, organization, and communication skills
• Ability to manage high-volume workloads and meet deadlines