This position is primary responsibility is a hybrid of customer/patient service telephone, project work and on line interaction for both hospital and physician inquiries and acts as an ambassador for the Revenue Cycle Management department providing patient centric access and service to incoming patient/family calls. The CSRs possess strong understanding of hospital and/or physician revenue management including coding processes, billing, insurance follow up and appropriate collection practices.
o Handles inbound and outbound customer calls minimally half the time to resolve inquires in a timely and accurate manner; in a patient focused manner that enhances the experience of patients and their families.
o Appropriately research and document all information from phone conversations and applies the appropriate transactions as appropriate to patient accounts;
o Works with internal and external resources as appropriate to support requests needed;
o Process payments by phone via electronic check, credit card, hard copy, payment database or any other approved means.
o Understand, explain, execute and help determine eligibility for hospital financial assistance programs.
o Assist patients with payment plan arrangements including collecting initial down payment as part of the process by following established departmental policy.
o Identify patient or customer needs, clarify information, research and analyze issues, and provide solutions and/or appropriate alternatives.
o Maintains patient and physician confidentiality and professionalism in accordance with departmental and HIPPA guidelines at all times.
o Consistently communicates issues and helps to review and implement people, process and technology improvements as appropriate.
o Performs various duties such as: Researching accounts, processing adjustments, refunds, and responding to patient correspondence that maximizes revenue collection.
o Process all necessary documentation to process system reports and work lists and correct patient accounts in accordance with established time frames to ensure account accuracy, increase revenue and promote positive public relations.
o Coordinates with agencies and other departmental vendors as appropriate to resolve patient accounts.
o Monitors self-pay accounts and reviews accounts according to department policies to refer to the outside collection agencies.
o Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct and appeal claims.
o Assists in the analysis of claims resolution and provides feedback to management to put in place solutions and process improvements.
o Assists in the development of new procedures/process with a focus on improvement in quality and quantity of work performed.
o Assists in the establishment of performance goals, monitors compliance.
o Enters charges and payments in accord with established guidelines, policies and procedures.
o Performs other duties as assigned.
*This role may encounter Protected Health Information (PHI) as part of regular responsibilities. UH employees must abide by all requirements to safely and securely maintain PHI for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.
Experience & Knowledge:
o Minimum 1 year medical billing / Accounting experience required.
o Customer service phone experience working with multiple screens required.
o Exceptional written and verbal communication skills required.
o Must consistently demonstrate advanced analytical and problem solving skills.
o Exceptional client service, communication, and relationship building skills required.
o Must be self-motivated and consistently demonstrate the ability to perform with little to no supervision in a fast-paced environment.
o Advanced knowledge of claim submission (UB04/HCFA 1500) and third party payers preferred.
o Advanced knowledge of medical billing and claims terminology and workflow processing strongly preferred.
Special Skills & Equipment Knowledge:
o Demonstrated proficiency with PCs, with HIS systems as well as Microsoft Office suite (including Word, Excel and Outlook), and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required.
o Experience with medical billing software required
o High School diploma or equivalent required.
Equal Opportunity Employer – minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity