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 responsibilities related to the management and operations of the front office in a medical practice. They may handle some or all of the 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 providers. Responsible for processing all payments and reconciling with daily computer reports. This role requires strong public interaction and exceptional interpersonal abilities. Facilitates patient pre-payments and upholds financial agreements prior to service delivery. Collects charge details, codes, inputs into the database, completes billing procedures, and disseminates billing information. Submits insurance claims and aids patients in filling out insurance paperwork. Manages overdue accounts by reaching out to patients and third-party payers. - 20%
  • Acts as a liaison between patients and medical staff. Welcomes patients and visitors in a timely, courteous, and supportive manner. Checks in patients, verifies and updates necessary insurance details in the patient accounting system. Secures signatures on all required forms and documents. Assists patients with mobility challenges. Maintains the appointment schedule and adheres to office scheduling protocols. Provides front office telephone support as needed through cross-training. Screens visitors and addresses routine inquiries. Responsible for gathering, accurately coding, and posting outpatient charges. Processes vouchers and private payments, updating registration screens based on check information. Conducts address verification as necessary. Assists in processing returned mail statements and outgoing statements. Collects billing information for all physicians for all patients seen in practice. Performs cashiering duties, including monitoring and balancing the cash drawer daily. Prepares daily cash deposits. Receives payments from patients and issues receipts. Codes and posts payments while maintaining necessary records, reports, and files. Collaborates with patients to secure prepayment sources or financial agreements before service delivery. Works with other staff to achieve account resolution. Aids in outpatient coding and error resolution. Processes edits and Customer Service and Collection Requests for resolution within designated timeframes. Identifies trends and communicates issues to management. Updates the patient account database. Maintains and refreshes current information on physician schedules. Schedules surgeries, ancillary services, and follow-up outpatient appointments and admissions as requested. Responds to inquiries regarding patient appointments and testing. Assembles patient charts for the next day’s visits. Updates profiles for all patients, ensuring completeness and accuracy. Oversees the waiting area, coordinates patient flow, and reports any issues or irregularities. - 20%
  • Assists patients with inquiries regarding insurance claims, obtaining disability benefits, home healthcare, medical equipment, surgical care, etc. Processes benefit correspondence, signatures, and insurance forms to expedite payment of outstanding claims. Aids patients in completing all necessary forms for hospitalization or surgical pre-authorization from insurance providers. Follows up with insurance companies to ensure coverage is approved. Records all actions and maintains a permanent record of patient accounts. Addresses patient questions and inquiries about their accounts. Confirms all workers' compensation claims with employees. Prepares disability claims promptly. Follows up with insurance companies to ensure claims are paid as directed. Maintains files with referral slips, medical authorizations, and insurance documentation. - 20%
  • Gathers all necessary information to complete the outpatient billing process, including obtaining charge information from physicians. Codes details about procedures performed and diagnoses on charges. Inputs charge information into the online entry system. Processes and distributes copies of billings according to clinic policies. Assists with outpatient coding and error resolution. Retrieves charts for scheduled appointments in advance. Delivers, transports, sorts, and files returned charts. Checks for misfiled charts and re-files according to the established system. Maintains organized files. Files all medical reports. Purges outdated records and files in storage. Destroys obsolete records following established retention and destruction procedures. Creates new patient charts. Repairs damaged charts. Aids in locating and filing records. Collaborates with medical assistants and other staff to route patient charts to the appropriate location. Adheres to medical records policies and procedures. - 20%
  • Collects payments at the time of service for outpatient visits. Reviews each account via computer to ensure timely payment of patient accounts. Engages in collection actions, including contacting patients by phone and resubmitting claims to third-party payers. Evaluates patient financial status and establishes budget payment plans. Reviews accounts for potential assignment to collection agencies and makes recommendations to the Clinical Department Practice Manager. Identifies and resolves patient billing issues. Collaborates with other staff to follow up on accounts until a zero balance is achieved or the account is turned over for collection. Participates in educational activities. Gathers and verifies superbills for specified practices daily. Inputs all charge and same-day payment information for patient visits and hospital patients, verifying the accuracy of coding, charges, and patient insurance status. Prints daily reports, ensuring charge entry balances at the end of the day. Backs up and closes computer files daily, logging as appropriate (i.e., closing all batches per policy). Registers new patients after verifying their status on the computer. Updates financial information as needed. Maintains strict confidentiality. Engages in educational activities. Performs related duties as required. As a representative of Prisma Health, individuals are expected to maintain a professional appearance, demonstrate a commitment to service at all times, and uphold the guidelines outlined in the office manual. - 20%

Supervisory/Management Responsibility

This position is non-management and reports 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 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.

Location

Not specified.

Facility

Not specified.

Department

Not specified.

Share your expertise with us. Our vision is straightforward: to transform healthcare for the benefit of the communities we serve. The transformation of healthcare necessitates skilled individuals in every role at Prisma Health.

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