Customer Service Representative

4 weeks ago

Oklahoma City, Oklahoma, United States Healthcare Partners Investments Full time
Job Summary

We are seeking a highly skilled Customer Service Specialist to join our team at the North OKC Medical Billing Office. As a key member of our Central Billing Office, you will be responsible for providing exceptional patient support functions, including customer service phone calls, resolving patient complaints, and researching and resolving patient questions.

Key Responsibilities
  • Provide patient-related support for the CBO according to policies and procedures.
  • Effective and efficient communication, computer, and phone skills.
  • Ability to work in a fast-paced environment with frequent interruptions.
  • Must understand the claim reimbursement process from the time the patient is seen until the claim is resolved in full.
  • Must be able to answer questions related to the claim status, whether balance is pending for third-party insurance or patient responsibility.
  • Must have excellent knowledge of third-party payor contracts, processes, and procedures.
  • Must be able to analyze an insurance EOB/correspondence and explain it to a patient in a concise and clear manner.
  • Must understand the CBO patient payment guidelines and the charity guidelines for each client.
  • Must exercise independent judgment and be able to resolve complex account issues, completing any necessary research needed.
  • Responsible for correcting issues found with claims, including demographic and insurance changes.
  • Representative must maintain a positive and highly professional working relationship with patients, physicians, and staff, facilities, and staff, co-workers, other departments, and any other entity they may have contact with in performing their daily duties.
  • Expected to stay informed and up to date on any rule or policy change in regards to their current position.
  • Employee is expected to be proficient in all systems, programs, and processes associated with their current position within the CBO.
  • Effectively working and cooperating with supervisors, co-workers, and clients.
  • Following the directions of supervisors.
  • Refraining from causing or contributing to disruption in the workplace.
  • Regular and reliable attendance.
  • Performs other duties as assigned.
Functional Accountabilities
  • Answers incoming phone calls in a prompt and courteous manner.
  • Returns all telephone messages within 24 business hours, with the exception of holidays.
  • Makes sure at all times that they are following HIPAA guidelines in all forms of communication.
  • Answers billing questions, explains balances due, evaluates and analyzes accounts to resolve customer questions/complaints.
  • Assists patients and/or guarantors with payment on account, budget arrangements, and patient discounts per established CBO policies.
  • Provides information, including paperwork, at patients' request, following all guidelines established by our 'release of information' policies.
  • Responsible for pulling needed paperwork from Onbase, archive, EMR, and client contact when needed.
  • Accepts payment over the phone by credit card or check by phone and sends to the appropriate department for processing.
  • Updates demographic and insurance data with information obtained from patients/guarantors and client staff.
  • Requests re-file of claim when warranted and follows up on any additional actions needed based on new information.
  • Does initial screening for charity when requested by patients and if patient meets criteria will send charity application.
  • Responds to patient correspondence by phone or mail and refers to other departments for resolution when appropriate.
  • CSR is responsible for contacting the client for any required information and ensures timely follow-up with the client until information is received or issue is resolved.
  • Forward claim issues that could not be resolved through the normal course of customer service efforts to the appropriate team or manager in a timely manner.
  • All patient complaints will be communicated to the Customer Service manager so that they can be tracked and reported to the appropriate staff.
  • Note clearly and precisely any and all actions taken on an account in the appropriate notes section of the current system.
  • All activity performed is noted on the patients' account in the appropriate billing system.
Requirements
  • Must be able to handle multiple assigned duties, including extensive phone time with patients and multi-billing systems.
  • Minimum 2-year experience required in healthcare customer service, billing, or collections and knowledge of insurance.
  • Current system experience preferred.
  • Bilingual skills preferred but not required.
  • High School graduate or equivalent required.
Benefits
  • Competitive benefits offered to full-time employees, spouses, and eligible dependents.
  • Medical benefits, including minimal out-of-pocket expenses for services provided by the company.
  • Dental benefits, including two in-network options for maximum savings and lower out-of-pocket expenses.
  • Vision benefits, including the largest national network of private-practice doctors.
  • Section 125 Plan offered, including pre-tax premiums for Medical, Dental, and Vision, as well as flexible spending for unreimbursed out-of-pocket eligible medical expenses and dependent care.
  • Company-paid Life Insurance policy for employees, with the option to purchase additional coverage for employees, spouses, and/or dependents.
  • Company-paid Long Term Disability, which goes into effect after an absence due to medical disability for more than 120 days.
  • Short Term Disability available for purchase to bridge the gap between being out and when Long Term Disability kicks in, if applicable, and allows employees to avoid exhaustion of paid time off.
  • Accident Insurance and Critical Illness coverage available for purchase on employees, spouses, and/or dependents.
  • 401(k) with a generous match.
  • Generous paid time off accrual program.
  • 7 paid holidays.

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