Customer Service Representative

Provide single point of contact for parents in regard to billing and insurance reimbursements of physician and hospital services. Respond to high volume, complex parent inquiries regarding billing issues. Research multiple hospital and physician service billing systems to resolve customer issues. Document activities and contact in systems. Develop detailed understanding of assigned managed care contractor and payor requirements. Minimum Education

High School Diploma or GED (Required)

Minimum Work Experience

3 years 3 – 5 years medical business office experience (Required)

Functional Accountabilities

Patient Services

Receive calls from parents regarding billing questions for physician and hospital services.

Review accounts with parents and communicate any complex billing information in a way that parents can understand; Work with parents to resolve billing concerns, following-up until needs are met.

May provide information in legal matters, with appropriate authorization.

May contact third party payors on behalf of parents to obtain additional information.

May provide further account itemization to parents; interpret EOB letters for parents.

Integrate information from multiple systems to develop responses to parents’ concerns. Billing Issues

Develop detailed knowledge of internal billing systems to research billing inquires for both physician and hospital services.

Identify source of any issue and the resources required to resolve in a timely manner; refer unresolved issues to manager.

Adjust overpayments and posting errors to accounts.

Within identified parameters, write-off account balances; recommend and refer larger write-offs to manager for approval, provide supporting documentation.

Document actions in system including research findings, write-offs, documentation sent, documentation requested etc.

May add insurance information to systems. Safety

Speak up when team members appear to exhibit unsafe behavior or performance

Continuously validate and verify information needed for decision making or documentation

Stop in the face of uncertainty and takes time to resolve the situation

Demonstrate accurate, clear and timely verbal and written communication

Actively promote safety for patients, families, visitors and co-workers

Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

Organizational Accountabilities

Program Knowledge

Understand managed care contracting requirements and apply principles for assigned payors.

As assigned, develop detailed understanding of state/federal assistance programs, e.g., Medicaid.

Understand federal and state regulations surrounding billing as it applies to assigned payors.Organizational Commitment/Identification

Partner in the mission and upholds the core principles of the organization

Committed to diversity and recognizes value of cultural ethnic differences

Demonstrate personal and professional integrity

Maintain confidentiality at all timesCustomer Service

Anticipate and responds to customer needs; follows up until needs are metTeamwork/Communication

Demonstrate collaborative and respectful behavior

Partner with all team members to achieve goals

Receptive to others’ ideas and opinionsPerformance Improvement/Problem-solving

Contribute to a positive work environment

Demonstrate flexibility and willingness to change

Identify opportunities to improve clinical and administrative processes

Make appropriate decisions, using sound judgmentCost Management/Financial Responsibility

Use resources efficiently

Search for less costly ways of doing things