Customer Service Representative - Customer Service

Position: Customer Service Representative - Customer Service - FT - Day
Position Status:

Full time

Shift: First Shift (Days - Less than 12 hours per shift) (United States of America)
Hours per week:40
* High School Diploma / GED Required
* Associate's Degree or equivalent undergraduate hours preferred.

Preferred Experience Qualifications
* 3 years Experience in healthcare financial services, healthcare registration services or related healthcare experience. Required

Skills and Abilities

* Working knowledge of basic medical terminology preferred.
* Keyboarding or typing skill of at least 30 wpm strongly desired.
* Proficiency in Microsoft Office (Word, Excel), email, and patient accounting systems preferred.
* Ability to read, analyze, and interpret healthcare regulations, payer correspondence, and technical documentation.
* Detailed knowledge of major third-party billing and contract requirements (required)
* Ability to work independently with strong analytical and problem-solving skills utilized to determine work prioritization, coordination, application of departmental procedures and resolve complex customer service issues. (Required proficiency).
* Strong written and verbal communication skills; able to present information clearly and respond effectively to patients, providers, and leadership.
* Proficiency in basic math, including calculations involving discounts, interest, and percentages; ability to apply basic algebraic concepts.
* Excellent interpersonal skills, with the ability to remain calm, respectful, and professional under pressure.
* Team-oriented mindset with a commitment to continuous improvement and patient-centered service

What you will do
* Respond to incoming calls, emails, and in-person inquiries to assist patients, families, and providers with billing, payment, and account-related concerns.
* Explain in depth to patients what their responsibility is (i.e.: deductible, co-insurance, copayments).
* Promptly follow up with appropriate parties to effectively resolve customer questions and problems. Maintain professionalism and empathy in all interactions.
* Accurately process payments, set up payment plans.
* Accurately apply uninsured, prompt pay, and ministry discounts in accordance with policy and productivity standards.
* Thoroughly research and resolve identified payment discrepancies in a timely manner including identifying and correcting posting errors (i.e. money applied to wrong account).
* Consistently and accurately documents accounts with activities as needed in a timely manner.
* Verifies accuracy of patient demographic and insurance information with patient or family members, documents and updates as necessary.
* Pre-screen patients for financial assistance or charity programs, provide applications, and respond to related inquiries in a timely and compassionate manner.
* Verify insurance eligibility, benefits, and network status. Coordinate multiple coverages and ensure compliance with Medicare, Medicaid, and other federal healthcare regulations.
* Clearly communicate the organization’s participating insurance plans to patients and refer them to alternative providers when necessary.
* Serve as a liaison between patients and internal teams such as Patient Experience, PFS management, or other departments to address complaints and determine appropriate resolutions.
* Ensure all customer concerns are handled in compliance with organizational policies, while upholding patient and employee rights, including confidentiality of health and personnel issues.
* Collaborate with internal departments and physician offices to ensure accurate and timely claims processing.
* Reconcile accounts, resolve denials, and pursue outstanding balances using payer remits, contracts, and policies. Identify and report patient and insurance credits to the appropriate department for resolution.
* Accurately calculate and communicate patient and insurance liabilities across all payer types. Determines correct contractual allowances.
* Attends and participates at departmental team meetings, work groups and other organizational educational programs.
* Identify and investigate duplicate Guarantor Accounts, then merge them to support timely and accurate self-pay billing.
* Create and explain good…