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Customer Service Representative-Business Office (714)
Department: BUSINESS SERVICES (11998310)
Schedule: Full time
Shift: Day Shift
About Facility:
Hours: Monday-Friday 8:00-4:30
Job Details:

JOB SUMMARY

Responds to all incoming patient correspondence and telephone inquiries by researching specific patient concerns regarding their clinic or hospital accounts and responding in a timely manner.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Researches and performs audits on patient accounts to determine where balances are due, from third party payers or patient responsibility.

Works with third party payers regarding payment denials to identify what the issue is. In depth understanding of third payer ANSI codes, their definitions, and what is needed to appeal certain denial codes by payer.

Thorough understanding of how to identify if charges on a patient's account are correct. In depth understanding of what information is available to assist the process, such as the medical record, Chartview, MPI, etc.

Ability to identify if a payment was posted erroneously, also familiar with managed care contract reimbursement rates. Understands terminology associated with contracts as well as familiar with the terminology and calculations used on a payment voucher and patient's explanation of benefits.

Understands how to rank multiple payers on a patient's account. Stays current with special billing arrangements and programs specific to Mercy Health System.

Responds to patient inquiries via mail, phone and/or email within 48 hours. Sends "stat" requests to appropriate work group and partner based on payer and assigned letter of the alphabet. Works with the appropriate partner as needed to resolve patient issue/question.

Understands Medicare reimbursement of DRGs, APCs or physician fee schedules.

Is fluent and knowledgeable in both the hospital and clinic patient accounting systems.

Researches both debit and credit balances to determine the third party payer or patient's liability. Initiates the refund procedure in the event monies are due back to the payer.

Documents all patient encounters on appropriate patient account/claim utilizing notes in both PLUS and Star. Ensures both systems are updated to accurately reflect the current status of an account.

Performs other duties as assigned.

COMPETENCIES

To perform the job successfully, an individual should demonstrate the following competencies :

Quality - Follows policies and procedures.; Adapts to changes in the environment.; Demonstrates accuracy and thoroughness.; Looks for ways to improve and promote quality.; Applies feedback to improve performance..

Service - Responds promptly to requests for service and assistance.; Meets commitments.; Abides by MHS confidentiality and security agreement.; Shows respect and sensitivity for cultural differences..

Partnering - Supports organization's goal and values.; Exhibits objectivity and openess to other's views.; Contributes to building a positive team spirit.; Generates suggestions for improving work..

Cost - Conserves organization resources..

Technical Skills - Strives to continuously build knowledge and skills; Shares expertise with others.

Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

Motivation - Measures self against standard of excellence.

Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently.

Professionalism - Approaches others in a tactful manner; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions.

Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity.

Safety and Security - Observes safety and security procedures; Reports potentially unsafe conditions ; Uses equipment and materials properly.

Attendance/Punctuality - Is consistently at work and on time; Arrives at meetings and appointments on time.

Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Completes tasks on time or notifies appropriate person with an alternate plan.

Initiative - Asks for and offers help when needed.

Design - Uses feedback to modify designs; Demonstrates attention to detail.

Problem Solving - Identifies and resolves problems in a timely manner; Works well in group problem solving situations.

Oral Communication - Listens and gets clarification; Responds well to questions; Participates in meetings.

Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Able to read and interpret written information.

Initiative - Volunteers readily; Undertakes self-development activities; Asks for and offers help when needed.

Innovation - Meets challenges with resourcefulness; Generates suggestions for improving work.

EDUCATION, TRAINING, & EXPERIENCE

High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.

Three months minumum experience in healthcare billing and follow-up for either third party payers or working with providers to process claims, and/or working with patients to resolve issues pertaining to their accounts

OTHER SKILLS AND ABILITIES

Medical Terminology helpful. Previous experience with billing of third party payers helpful. Basic knowledge of CPT or diagnosis codes helpful.

WORK ENVIRONMENT

The noise level in the work environment is usually moderate.

SPECIAL PHYSICAL DEMANDS

While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision.

Language Skills

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Computer Skills

Basic computer skills, familiarity with computers, ability to type on a key board.

To perform this job successfully, an individual should have knowledge of Spreadsheet software and Word Processing software.

Basic understanding of where and which system houses information, understands the relationship between systems and what purpose each system serves, for example Star and Plus to Claims Administrator or electronic remittances from the payer to Star or Plus.

CERTIFICATION/LICENSURE

In lieu of experience, completion of the Advanced Patient Billing Class or Certification in Patient Accounting (AAHAM - CPAT).


EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Acton Plans.

   
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