Healthcare Customer Service Representative

Job Title : SBO Customer Service Specialist

Reports to: Director of SBO

Position Summary:

The Self-Pay Billing Office (SBO) & Customer Service unit is responsible for responding to all incoming inquiries from patients, departments, various billing agencies and other external inquiries. The representative in this team has frequent contact with patients, Patient Financial Services staff, clinic and hospital staff and management, and managers, as well as billing and professional fee and collection services vendors.

The SBO Customer Service Specialist has a thorough knowledge of WWT & UI Health insurance contracts as the unit deals regularly with complex policy and procedural issues that involve contract compliance regarding HMO, PPO and government payers. Negotiates prompt payment discounts, sets up payment plans according to departmental guidelines, and has a working knowledge of the organization’s discount and charity policy. Provides relevant information to mitigate escalation and 2 nd level disputes.

This position will process all customer service inquiries and follow-ups with quality, compassion and assertiveness. Performs analysis to take appropriate action on information or documents received. Meets WWT & UI Health guidelines, government and HIPAA policies and procedures by utilizing multiple databases and applications. Applications and Databases consist of: Epic, DataArk (McKesson), Availity, MEDI, On-BaseMS Outlook, MS Excel, MS Word, Medicare Connex, One Source and other payer websites.

Essential Duties and Responsibilities:

Handles all customer service in-bound call queues for collections, payments, and disputes

Ensure service levels are met and abandonment rates and RONAs are kept to a min.

Answers patient concerns regarding the balance inquiries, itemized bill requests and questions about their statements.

Assist patients with understanding their balance of statements and provide the available payment option that best suits their needs.

Provides first level financial assistance screening for patients that may qualify for Medicaid coverage or charity care including creating cases for FCMU follow up.

Updating patient demographics such insurance coverage, address, employer or covered member information.

Prepares accounts for resubmission of claims to insurance payers when applicable.

Initiates, route and follow-up on patient disputes regarding charges or coding issues based on workflows.

Ensures accurate billing practices on patient accounts were applied

Resolves operational statement hold reasons such as missing address or zip code, credit balances, unbilled coverages, etc.

Research and resolve a minimum of 25 accounts or guarantor accounts daily from WQ’s for DNBI, Fin. Assist screening, coverage changes, etc.

Responds to patient inquiries/concerns received by telephone or mail within 48 hours not to exceed 30 days of receipt.

Clarifies understanding of the inquiry/concern, determines the appropriate course of action, initiates and/or completes appropriate action, resolves patient complaints and does appropriate customer service recovery when required.

Research and processes accounts subject to bankruptcy regulations or legal actions.

Running individual time log reports to ensure effective time management and efficiency.

Other duties as assigned

Knowledge, Skills & Abilities

Previous call center or customer service experience in the medical field required.

Working knowledge of Epic is preferred.

Demonstrate an in-depth understanding of all aspects of billing procedures consistent with those performing insurance follow-up activities both hospital and professional billing environment

Working knowledge of insurance billing requirements, UB04 and HCFA 1500 claim forms, EOBs, Workers’ Compensation, Personal Injury, HMOs, PPOs, MCO, Medicare, Medicaid and compliance program regulations.

Basic understanding of CPT, ICD, DRG, and HCPC codes.

Excellent interpersonal, verbal, and written communication skills

Ability to demonstrate cultural sensitivity and a respectful, courteous and professional manner in all interactions

Ability to balance assertiveness with compassion, empathy and patience for the patient and others

Ability to effectively handle difficult customer situations on the phone and de-escalate the situation.

Critical thinking and use good judgment in decision making.

Good analytical and organizational skills

Motivated individual with a positive outlook and exceptional work ethic

Ability to consistently follow direction, processes and written procedures

Thorough knowledge of computer operation, keyboard functions, calculator, copier and fax machine operation with standard keyboard skills

Computer software skills (i.e. Microsoft Applications and E-mail, etc.)

Thorough understanding of HIPAA rules and regulations

Bi-lingual Spanish-speaking a preferred

Self-starter with strong sense of ownership, assertive follow-through and orientation toward results.

• Education/Experience :
• High School diploma or equivalent required. Experience should demonstrate expert level knowledge of analyzing and resolve complex problems in a quick and effective manner. Must have the ability to analyze and interpret data, good problem-solving skills and initiative. Experience should also demonstrate the use of effective communication skills with patients and staff; demonstrate proper telephone techniques and etiquette; shows sensitivity to differences of culture; demonstrates a positive and supportive manner in which patients / families/ colleagues perceive interactions as positive and supportive. Exhibits teamwork skills to positively acknowledge and recognize other colleagues and uses personal experiences to model and teach within organizations standards.