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 inquiries 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 over payments 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 take 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.

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 uphold 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 times.

Customer Service

• Anticipate and respond to customer needs; follow up until needs are met.

Teamwork/Communication

• Demonstrate collaborative and respectful behavior.
• Partner with all team members to achieve goals.
• Receptive to others’ ideas and opinions.

Performance 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 judgment.

Cost Management/Financial Responsibility

• Use resources efficiently.
• Search for less costly ways of doing things.

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