Healthcare Customer Service Representative

1 week ago

West Columbia, South Carolina, United States Prisma Health Full time

Empower health. Serve with empathy. Make an impact.

Position Overview

Individuals in this role are tasked with various elements of front office management and operations within a medical practice. Responsibilities may encompass a range of front office duties as outlined below.

Key Responsibilities

  • Ensure thorough and precise patient registration, pre-authorization, charge documentation, and accurate coding of diagnoses as provided by healthcare professionals. Manage payment postings and reconcile with daily computer reports. This role necessitates a high degree of public interaction and exceptional interpersonal abilities. Facilitate patient pre-payments and uphold financial agreements prior to service delivery. Collect charge data, code, input into the system, finalize billing processes, and disseminate billing information. Submit insurance claims and assist patients in completing necessary insurance documentation. Address outstanding accounts by reaching out to patients and third-party payers. - 20%
  • Act as a liaison between patients and medical support personnel. Welcome patients and visitors in a timely, courteous, and supportive manner. Check in patients, confirm and update essential insurance details in the patient accounting system. Secure signatures on all required forms and documents. Aid patients with mobility challenges. Maintain the appointment schedule and adhere to office scheduling protocols. Provide front office telephone support as necessary and outlined through cross-training initiatives. Screen visitors and respond to routine inquiries. Responsible for gathering, accurately coding, and posting outpatient charges. Process vouchers and private payments, updating registration screens based on check information. Investigate address verification as needed. Assist in processing returned mail statements and outgoing correspondence. Collect billing information for all physicians for all patients seen in practice. Execute cashiering duties, including monitoring and balancing the cash drawer daily. Prepare daily cash deposits. Accept payments from patients and issue receipts. Code and post payments while maintaining necessary records, reports, and files. Collaborate with patients to secure prepayment sources or financial agreements before service provision. Work alongside other staff to achieve account resolution. Assist with outpatient coding and error resolution. Process edits and customer service requests for resolution within specified timeframes. Identify trends and communicate issues to management. Update patient account databases. Maintain and refresh current information on physician schedules. Schedule surgeries, ancillary services, and follow-up outpatient appointments and admissions as requested. Address inquiries regarding patient appointments and testing. Assemble patient charts for upcoming visits. Update profiles for all patients, ensuring completeness and accuracy. Oversee the waiting area, coordinate patient flow, and report any issues or irregularities. - 20%
  • Assist patients with inquiries regarding insurance claims, obtaining disability benefits, home healthcare, medical equipment, surgical care, etc. Process benefit correspondence, signatures, and insurance forms to expedite the payment of outstanding claims. Aid patients in completing all necessary forms to secure hospitalization or surgical pre-authorization from insurance providers. Follow up with insurance companies to ensure coverage is approved. Document all actions and maintain a permanent record of patient accounts. Address patient questions and inquiries concerning their accounts. Confirm all workers' compensation claims with employees. Prepare disability claims promptly. Follow up with insurance companies to ensure claims are processed as directed. Maintain files containing referral slips, medical authorizations, and insurance documentation. - 20%
  • Investigate all information required to complete the outpatient billing process, including obtaining charge details from physicians. Code information regarding procedures performed and diagnoses on charges. Input charge information into the online entry system. Process and distribute copies of billings in accordance with clinic policies. Assist with outpatient coding and error resolution. Retrieve charts for scheduled appointments in advance. Deliver, transport, sort, and file returned charts. Collect lab reports, dictations, X-rays, and correspondence. Regularly check for misfiled charts and refile according to the established system. Maintain organized files. File all medical reports. Purge obsolete records and files in storage. Dispose of outdated records following established retention and destruction procedures. Create new patient charts. Repair damaged charts. Assist in locating and filing records. Collaborate with medical assistants and other staff to route patient charts to the appropriate location. Adhere to medical records policies and procedures. - 20%
  • Collect payments at the time of service for daily outpatient visits. Review each account via computer to ensure timely payment of patient accounts. Conduct collection actions, including contacting patients by phone and resubmitting claims to third-party payers. Assess patient financial status and establish budget payment plans. Review accounts for potential assignment to collection agencies and make recommendations to the Clinical Department Practice Manager. Identify and resolve patient billing issues. Collaborate with other staff to follow up on accounts until a zero balance is achieved or turned over for collection. Participate in educational activities. Gather and verify superbills for specified practices daily. Enter all charge and same-day payment information for patient visits and hospital patients, verifying the accuracy of coding, charging, and patient insurance status. Print daily reports, ensuring charge entry balances at the end of the day. Back up and close computer files daily, logging as appropriate (i.e., closing all batches in accordance with policy). Register new patients after verifying their status in the computer system. Update financial information as necessary. Maintain strict confidentiality. Engage in educational activities. Perform related tasks as required. As a representative of Prisma Health, maintain a neat and professional appearance, demonstrate a commitment to service at all times, and uphold the guidelines set forth in the office manual. - 20%

Supervisory/Management Responsibility

This position does not involve management responsibilities and will report to a supervisor, manager, director, or executive.

Minimum Qualifications

High School Diploma or equivalent.

No prior experience required.

Required Certifications/Registrations/Licenses

N/A

Alternative Qualifications

N/A

Additional Required Skills and Experience

  • Associate's Degree in a technical specialty program of at least 18 months in duration - Preferred
  • Experience in a multi-specialty group practice setting - Preferred
  • Basic understanding of ICD-9 and CPT coding - Preferred

Work Schedule

Day shift.

Facility Overview

Join us in our mission to transform healthcare for the benefit of the communities we serve. The transformation of healthcare requires talented individuals in every role at Prisma Health.

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