Description
A Brief Overview
This position is primary responsibility is a hybrid of customer/patient service telephone, project work and on line interaction for billing 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. Comprehensive knowledge of internal workflow processes and ancillary systems to quickly analyze and understand how to resolve incoming patient questions/requests related to a various components of billing including payer adjudication and processes. Strong problems solving skills required, including researching documentation and patient account history to help resolve recurring calls. Comprehensive knowledge of UH entity collection and financial assistance policies required in order to support questions/inquiries from under/uninsured patients. Works harmoniously with staff and teams as appropriate CSR must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements. System savviness and proficiency is needed across multiple financial, payer, ancillary and other applications used in documenting patient account information. CSR supports and is engaged in all consumerism and price transparency initiatives to ensure that exceptional service is provided and financial needs to our patients are consistently met. Engagement and recommendation on further developments of these initiatives is expected as a result of patient interaction. The CSR supports department and leadership with performing department projects, provides financial counseling support, review and resolve departmental reports/work lists as well as other departmental duties as assigned. The position works closely with patients/families, staff and leadership to coordinate support and handoffs between Pre-billing/billing, Financial Counselors, Customer Service, Self-Pay Collections and Physician A/R teams to optimize patient experience and collections. The CSR fully understands customer service key performance indicators and works to consistently achieve these metrics including patient satisfaction through survey submission, productivity, average speed to answer, call wait times and abandon rates setting performance standards for the department.
What You Will Do
- 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.
- Appropriately research and document all information from phone conversations and applies the appropriate transactions as appropriate to patient accounts;
- Works with internal and external resources as appropriate to support requests needed;
- Process payments by phone via electronic check, credit card, hard copy, payment database or any other approved means.
- Understand, explain, execute and help determine eligibility for hospital financial assistance programs.
- Assist patients with payment plan arrangements including collecting initial down payment as part of the process by following established departmental policy.
- Identify patient or customer needs, clarify information, research and analyze issues, and provide solutions and/or appropriate alternatives.
- Maintains patient and physician confidentiality and professionalism in accordance with departmental and HIPPA guidelines at all times.
- Consistently communicates issues and helps to review and implement people, process and technology improvements as appropriate.
- Performs various duties such as: Researching accounts, processing adjustments, refunds, and responding to patient correspondence that maximizes revenue collection.
- 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.
- Coordinates with agencies and other departmental vendors as appropriate to resolve patient accounts.
- Monitors self-pay accounts and reviews accounts according to department policies to refer to the outside collection agencies.
- Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct and appeal claims.
- Assists in the analysis of claims resolution and provides feedback to management to put in place solutions and process improvements.
- Assists in the development of new procedures/process with a focus on improvement in quality and quantity of work performed.
- Supports all developed price transparency initiatives and can educate and/or direct the patient accordingly
- Assists in the establishment of performance goals, monitors compliance.
Additional Responsibilities
- Performs other duties as assigned.
- Complies with all policies and standards.
- For specific duties and responsibilities, refer to documentation provided by the department during orientation.
- Must abide by all requirements to safely and securely maintain Protected Health Information (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.
Qualifications
Education
- High School Equivalent / GED (Required)
Work Experience
- 1+ years in medical billing, financial environment or customer service experience (Required) and
- Experience with medical billing software (Required)
Knowledge, Skills, & Abilities
- Hospital and physician billing knowledge (Preferred proficiency)
- Customer service phone experience working with multiple screens (Preferred proficiency)
- Exceptional written and verbal communication skills. (Required proficiency)
- Must consistently demonstrate advanced analytical and problem solving skills. (Required proficiency)
- Exceptional client service, communication, and relationship building skills. (Required proficiency)
- Self-motivated and consistently demonstrate the ability to perform with little to no supervision in a fast-paced environment. (Required proficiency)
- Advanced knowledge of claim submission (UB04/HCFA 1500) and third party payers. (Preferred proficiency)
- Advanced knowledge of medical billing and claims terminology and workflow processing. (Preferred proficiency)
- Self-motivated, works independently and consistently demonstrates the ability to perform with little to no supervision in a fast-paced environment. (Required proficiency)
- Demonstrated proficiency with PCs, with HIS systems as well as Microsoft software Microsoft Office suite (including Word, Excel and Outlook), and general office equipment (i.e. printers, copy machine, FAX machine, etc.). (Required proficiency)
Physical Demands
- Standing Occasionally
- Walking Occasionally
- Sitting Constantly
- Lifting Rarely 20 lbs
- Carrying Rarely 20 lbs
- Pushing Rarely 20 lbs
- Pulling Rarely 20 lbs
- Climbing Rarely 20 lbs
- Balancing Rarely
- Stooping Rarely
- Kneeling Rarely
- Crouching Rarely
- Crawling Rarely
- Reaching Rarely
- Handling Occasionally
- Grasping Occasionally
- Feeling Rarely
- Talking Constantly
- Hearing Constantly
- Repetitive Motions Frequently
- Eye/Hand/Foot Coordination Frequently
Travel Requirements
