PBS Specialist

PBS Customer Service Specialist The PBS Customer Service Specialist is responsible for creating a positive patient experience while interacting with customers regarding patient inquiries in a high-volume call center and/or in person. The Specialist will work to review and resolve patient inquiries, complaints and grievances by phone, via MyChart, via Zoom and in writing in a courteous and professional manner that is both caring and compassionate. This individual maintains positive working relationships with our internal and external customers and vendors. The Specialist will provide details regarding billing inquiries and needed information, such as itemized statements and patient account summaries in our electronic health record (EPIC). Specialists also manage estate and bankruptcy processes for referral to the Office of General Counsel, in addition to referral and review of accounts in bad debt. The Specialist must be able to utilize critical thinking skills to analyze problems and review and resolve billing inquiries and complaints. This individual must be able to multi-task in a fast-paced environment and will need exceptional customer service skills, appropriate phone etiquette and a willingness to serve others. The Specialist will need a working knowledge of healthcare billing (hospital and physician) and the ability to review and explain how claims processed according to the Explanation of Benefits. This individual needs to be comfortable discussing and collecting patient balances. Specialists will need to adhere to all department's policies and procedures. The Specialist will work under the guidance of the Patient Business Center Customer Service Supervisor and will be responsible for timely escalation of patient concerns to the Supervisor for resolution. 1. Manages a high volume of complex inquiries in EPIC and resolves concerns within 24-48 hours. 2. Utilizes critical thinking skills not only to make judgements on accounts but also to ensure that patients concerns are addressed fully. 3. Work with Patient Advocacy to address patients' concerns. 4. Address correspondence and MyChart requests and follow up with patients within 24-48 hours 5. Load/ Link insurance information 6. Review accounts during interactions to ensure all demographic information is valid and up to date 7. Review accounts for possible refund due and communicates any refund request to the Credit Resolution Team 8. Must be able to perform analysis on all accounting systems assuring billing of total charges, verification of payment postings, contractual adjustments and report valid account information 9. Always Adheres to the ABC's of customer service by adhering to the greetings established for the department 10. Receives and responds to incoming calls from providers and representatives from insurance companies providing information necessary to expedite claim processing and resolution 11. Follows up on aged balances identified during each encounter with patients and work towards immediate resolution 12. Reviews the patients accounts in its entirety to resolve the complete account; undistributed balance, aged balances, refund pending 13. Must have excellent written and oral communication skills 14. Advises patients of all aged balances and attempt to collect 15. Maintain all assigned work queues by not lagging beyond 30 days with no follow up activity documented 16. Completes payment plan request timely and accurately according to the guidelines established by the department 17. Achieves the annual collection goals established by the department 18. Work independently and deal effectively with stress as a result of heavy workload and the handling of complex patient inquiries 19. Notifies management timely on accounts that indicates delinquency according to the payment plan contract 20. Must be knowledgeable in reviewing balances in the Epic systems for the PB (professional billing) and HB (hospital billing) and understands how to add insurance information for billing purposes 21. Manage estate and bankruptcy processes for referral to the Office of General Counsel, in addition to referral and review of accounts in bad debt 22. Prevent PHI/HIPAA violations 23. Ability to access resources available to accurately make decisions 24. Meets the daily production standard established for the department 25. Must maintain at least achieves on the quarterly report card 26. For patients participating in a clinical trial, appropriately document and review with patients and the payors services being covered by the clinical trial sponsor and those designated for coverage under the patient's insurance 27. Promptly escalate any issues with the Patient Business Services Customer Service Supervisor or seek assistance as appropriate from Patient Advocacy for cases involving complaints regarding services received 28. Completely and accurately document conversations and communication with payors, third party vendors, patients, and any other representative in and outside of the institution 29. Conducts all Customer Service activities in a courteous and professional manner and maintains a positive working relationship with patients, physicians, payors, third party vendors and any other identified business partners 30. Seeks to improve job performance and personal growth by participating in available and required educational, training and mentoring opportunities 31. Perform all other duties as assigned *EDUCATION* * Required: Associate's Degree Business Administration or related field. * Preferred: Bachelor's Degree Business Administration or related field. *WORK EXPERIENCE* * Required: 4 years in healthcare to include two years experience in billing, governmental regulations and/or claims adjustment. * May substitute required education degree with additional years of equivalent experience on a one to one basis. *Preferred Experience/Skills:* Five years of healthcare experience in customer service, experience working in a call center in healthcare related, high prefer billing experience, insurance follow-up, collections, cash posting, credits resolution, or bad debt management in medical or hospital business office setting. Work Schedule: This position is onsite. Other Requirements: Must pass pre-employment skills test as required and administered by Human Resources.