Customer Service Specialist I

6 days ago

Costa Mesa, United States Hoag Health System Full time
Salary Range: 22.00 - 32.03 /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.

This individual projects an image of professionalism in communication and conduct at all times to ensure a positive experience for the patient, physician, visitor, colleague or partnering departments. The Patient Scheduling Specialist mission is to maintain a patient centric philosophy throughout all processes and procedures. They are the initial contact representative for a patient or physician calling Hoag Hospital in which to establish appointments, inquire about financial questions, Hoag Portal, pre registration, exam preparation and coordination of services. They function as a liaison for those we serve and possess an extensive knowledge of the actual procedures, precertification, and financial requirements unique within each contract, department or facility under the Hoag brand.

Level 1:

This position requires the ability to perform all functions within the SERVE (Schedule, Educate, Register, Verify and Estimate essential job functions. Estimation requires scheduler to submit to eligibility vendor and eligibility team for patient follow-up for a patient. Effectively handles 30+ transactions per day for several different departments and services with minimal or no error. This level can take calls from main department line. This level can include staff that pre register and schedule for one or two departments in addition to other departments of radiology or new departments for CPS. This level meets all requirements for excellent customer service by maintaining excellent patient and physician satisfaction rating. Schedulers in this level are reviewed after 6 months of scheduling in multiple departments to determine expertise to Level II scheduling.

Essential Functions

  • Extensive knowledge of scheduling and preparation of procedures and visits for all departments within Hoag Enterprise using the Unibased System and interfacing clinical systems and ADT system. Escalates issues or concerns to ensure the optimizing of services delivered with minimal impact.
  • Overall knowledge of the revenue cycle process, registration, insurance verification, precertification, billing compliance, payer contracts, patient estimation, financial assistance, ICD9, CPT, CMS regulations, DNFB and claim processing. The SERVE TEAM, schedules, educates registers, verifies and estimates services for the patient with a “one call does it all” initiative.
  • Responsible for accurately scheduling appointments within a centralized department, which provides education to the patient and offices, full patient registration, verification of insurance, precertification requirements for services, patient estimation of services, collection of co-pay, deductibles and coinsurance as required. Providing the patient with comprehensive service thereby reducing call transfers, redundancy of questions, and unnecessary call back to the patient
  • Participates as a key member of the SERVE Team, maintaining hospital initiatives, mission and vision to ensure a high quality patient experience. Partners with clinical departments on policy and scheduling implementation and changes. Provides service to those departments maintaining quality SERVE responsibilities.
  • Serves as a resource for problem solving and communications. Analyzes the patient feedback for process/system resolution when appropriate. Knowledgeable of resolution process and outcomes of ongoing patient complaints and concerns.
  • Utilizes protocol for patient look up to ensure accurate identification of patient to ensure data integrity and patient safety
  • Accommodates requests from patient and physician offices for STAT same day procedures. Effectively prioritize calls using courteous professional demeanor to ensure high patient satisfaction.
  • Ensures prescription orders from physician’s meets hospital compliance for signatures, diagnosis, and services to ensure hospital coding for submission of clean claim.
  • Obtains and evaluates all relevant data to handle complaints and inquiries. Resolves customer support related issues and provides customer with proper solution, via troubleshooting techniques. Performs duties independently and uses judgment in handling a variety of patient experience issues.
  • Maintain required productivity volumes based on expected skills and specifications for current level. Performs customer verifications, processing orders and requests. Completes call reports, logs, work-lists and respond to billing issues.
  • Effectively uses multiple software systems to complete schedule/registration process.
  • Completes incoming requests from external customers by email or fax and manages their inquiries or requests. Completes outbound and inbound calls from external and internal customers.
  • Promptly and courteously answers and screens phone calls for the office or department; routes call as appropriate within established customer service guidelines; accurately records messages and delivers to the appropriate party in a timely manner; checks voicemail frequently.
  • Effectively screens and edits confidential correspondence and documents related to patient care and sensitive administrative issues in accordance with established policies and procedures. Coordinates changes, postponements, cancellations and preferred order of cases with physicians, patients and department staff. Informs departments of possible conflicts on use of equipment. Coordinates posting of procedures with multiple departments.
  • Coordinates procedures with other departments in a timely manner; accurately completes documents, forms, insurance eligibility and authorizations. Clearly communicates directly with departments as needed. Also coordinates anesthesiology coverage for specific procedures.
  • Acts as a liaison between hospital and patient/family regarding financial matters while patient is on the phone.
  • Counsels and advises the patient concerning financial alternatives and program options.
  • Develops knowledge and stays current regarding insurance, government programs and the requirements for all insurances.
  • Provides directions to patients regarding appointments, preps and other departments with required information to ensure efficiency of appointment.
  • Understands the compliance for medical necessity and ABN regulations to meet CMS guidelines.
  • Accurately performs computer functions to include SMS, Unibased, RIS, Fax manager, Passport, ECashiering, Chartmaxx, HIER, EMR, 3M, SmartID, RQI, inContact and additional software as established.
  • Communicates to the patient all prior film requirements prior to services.
  • Screens patients for potential allergies, completes and forwards appropriated documentation as required including submission to specific work lists for follow-up.
  • Maintains current knowledge of departmental and policy updates.
  • Adapts to special patient needs to promote cooperation and improve the patient experience.
  • Transfers customer calls with complex inquiries to staff with appropriate skill level.
  • Recommends process improvements and remains engaged in daily productivity levels and customer satisfaction. Recognizes documents and informs the supervisor regarding the trends in internal and external customer calls. Assists department management to identify staff education and training needs.
  • Active and participates easily in a team environment that is fast paced. Flexible, proactive and preserving to meet positive patient experience.
  • Offers guidance, assistance and direction to less experienced personnel.
  • Perform other duties as assigned.

Required:

Education, Training and Experience

Level I:

  • High School Diploma or equivalent.
  • Complete 1 year of employment in Access Department or Front Desk scheduling or customer service experience.

Preferred:

Level I:

  • Background in billing, collections, insurance verification, coding, patient access or appointment scheduling.
  • College degree in related field.

Level I:

Skills or Other Qualifications

  • Intermediate level knowledge of windows computers with solid keyboard data entry skills and working knowledge of basic office equipment.
  • Ability to multitask constantly and tolerate interruptions.
  • Good organizational and follow-through skills.
  • Position requires fluency in English language to function in job environment appropriately.
  • Excellent communication skills; interpersonal, written and verbal.
  • Ability to perform basic arithmetic computation to determine deposits, perform cashiering functions.
  • Medical terminology or strong understanding of medical terms.
  • Ability to type minimum of 35 words per minute.

Level I:

  • Previous experience scheduling procedures within a medical setting.
  • Working knowledge of eligibility and working provisions of payers

License and Certifications

Preferred:

  • Medical Terminology certification

About Hoag

Hoag is a nonprofit, regional healthcare delivery system in Orange County, California. Delivering world-class, comprehensive, personalized care, Hoag consists of 1,800 top physicians, 15 urgent care facilities, 10 health and wellness centers, and two award-winning hospitals. Hoag offers a comprehensive blend of health care services that includes seven institutes providing specialized services in the following areas: cancer , digestive health , heart and vascular , neurosciences , spine , women's health , and orthopedics through Hoag's affiliate, Hoag Orthopedic Institute , which consists of an orthopedic hospital and four ambulatory surgical centers. Hoag is the highest-ranked hospital in Orange County by U.S. News & World Report and the only OC hospital ranked in the Top 10 in California, as well as a designated Magnet hospital by the American Nurses Credentialing Center (ANCC). For more information about Hoag careers, visit careers.hoag.org .

Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.

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