Overview

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
• 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.

Last updated : 2024-04-23