Customer Service Coordinator

2 weeks ago

Green Bay, Wisconsin, United States Advocate Health Full time
Job Summary

We are seeking a highly skilled and detail-oriented Customer Service Coordinator to join our team at Advocate Health. As a key member of our HME business line, you will be responsible for ensuring seamless transitions for patients from hospital to home, while optimizing insurance benefits and providing exceptional customer service.

Key Responsibilities
  • Evaluate HME referrals and service orders to ensure timely and smooth transitions for patients, while ensuring insurance benefits are optimized.
  • Advocate for patients as a liaison, explaining prescription orders, hospital transitions, and home start of care processes, as well as insurance benefits.
  • Access service requests in relation to organization acceptance criteria and evaluate medical documentation to ensure payer coverage criteria are satisfied.
  • Verify patient insurance benefits and eligibility, and contact insurance plans to obtain service prior authorization as needed.
  • Provide direction to physicians on how to resolve documentation or medical management gaps when documentation does not support medical necessity or payer coverage criteria.
  • Identify risk issues and collaborate with patients, physicians, hospital staff, and other care providers to ensure resolution and patient safety.
  • Coordinate timely provision of service with distribution operations and the patient.
  • Provide quality customer service for all customers, including patients, physicians, referral sources, and coworkers within Advocate Health and external customers.
  • Be proficient in the use of computerized resources and data entry programs, involving proper processing and qualifying of patients with HME business line needs.
  • Monitor and work all necessary insurance verification reports for assigned product lines and assigned payors.
  • Run, collect, and tabulate data and submit to management selected and assigned reports.
  • Identify, investigate, and verify sources of reimbursement and make recommendations based on the information obtained.
  • Obtain and document payor eligibility information for each new referral, addition to service, and re-admission, and determine if payor's coverage requirements are met for services or equipment.
  • Assess potential third-party liability cases to determine who is the primary payor and relay the appropriate billing requirements to the patient's accounts staff and operations.
  • Provide pricing information to explain the financial responsibility to patients, assessing their ability to pay and negotiating payment plans as needed.
  • Participate in performance improvement and patient satisfaction initiatives, serving as a member of department, division, or system performance or process improvement groups as appropriate.
  • Continuously update knowledge of Medicare, Medicaid, HMO, and managed care coverage requirements and guidelines.
Requirements
  • Typically requires 5 years of experience in medical entry, claims processing, HME business line, home care, insurance verification, home care customer service, or other healthcare-related positions.
  • Knowledge of HME/RT equipment and understanding of third-party payors, including Medicare, Medicaid, and private insurance companies.
  • Regularly interfaces with representatives of third-party payers and has wide-ranging contacts with hospitals, long-term care facilities, rehab and therapy facilities, physician's offices, case managers, utilization review managers, patients, and their families.
  • Determine acceptance of patients with low financial risk, high-risk cases, and appropriately seek out resources.
  • Prioritize insurance verification and prior authorization to ensure department goals and objectives are obtained.
  • Monitor all managed care patients' supply orders and re-orders to ensure adequate and current authorization is in the database.
  • Troubleshoot equipment problems and seek further assistance as needed.
  • Handle confidential information on every client.
  • Function under tight time constraints to verify insurance benefits before delivery of equipment and data entry of referral information necessary for delivery tickets with proper qualifying diagnoses.
  • Heavy volume of daily incoming and outgoing phone calls and documents must be processed timely and accurately.
Working Conditions
  • Exposed to an office environment.
  • Must be able to sit, stand, and walk for long periods of time.
  • Must have the physical agility to move about in confined spaces, including bending, kneeling, squatting, and occasionally reaching one or both arms over head.
  • Must be capable of typing, writing, and data entry for prolonged periods of time.
  • Will occasionally lift 10 lbs.
  • Operates all equipment necessary to perform the job.

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