Patient Financial Services Cost of Care Representative
4 weeks ago
The PFS Cost of Care Rep is responsible for providing customers with timely and accurate payment and pricing estimates with outstanding customer service. The Cost of Care Rep will work directly with ancillary departments, contracting, pricing, government payment and pricing staff, insurance carriers, and other external/internal resources to provide customers with appropriate payment and pricing information. Responsibilities include patient education, insurance verification, and excellent written and verbal communication.
Responsibilities/Job Description:
Obtain required demographic, coding & payor information
Provide customer friendly education on required data elements for calculating payment and pricing and scope of service that will be provided
Able to convert complete information into customer friendly education
Verify insurance eligibility via on-line access or by phone
Utilize familiarity with payors and plans to confirm coverage
Model estimates for self-pay and insured customers using required tools
Understand Managed care payment methodologies including APC, DRG, per diem, fee schedules, etc.
Analyze output for reasonableness using knowledge of payment methodologies and charge structures
Adjust data and re-calculate if necessary
Finalize estimates
Communicate outcome of estimate
Call customer within established timeframe to communicate estimate and send follow up if requested
Provide education to customer regarding additional questions
Receive customer feedback regarding the estimate
Direct customer to other resources as needed
Respond to all concerns / inquiries in a timely and professional manner
Provide response to customers that meets or exceeds turn-around time expectations including providing live estimates to patients over the phone for procedures with estimate templates created
Accountability to follow through on turn-around time requirements
Self-manage daily workload to follow through on and complete issues
Ability to work independently and apply critical thinking
Take initiative to prioritize and meet deadlines
Escalate issues as needed to meet and/or exceed customer expectations
Participate in meetings with internal and external departments as requested
Qualifications:
Required
Two or more years of customer service experience with one or more of those years in healthcare customer service.
Preferred
One or more year of experience providing cost of care information to customers.
Excellent communication skills.
Ability to communicate, as needed, both verbal and written information in a clear, concise, accurate and considerate manner.
Proven ability to problem solve effectively.
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