Customer Service Representative I

Essential Functions

• Delivers an exceptional Patient Financial experience by receiving and directing the public, by telephone or other electronic means, in a professional and courteous manner and with consciousness and sensitivity to the diversity of the organization and its patients' needs.
• Manages a high volume of inbound calls, answers patient inquiries, and determines the appropriate path for resolution and follow-up.
• Demonstrates excellent customer service and expertise to patients, guarantors, and other external and internal contacts through oral and written communication.
• Responds to and documents all patient and internal inquiries regarding hospital and professional visits in the patient billing platform as they relate to the patient financial experience.
• Understands varying business processes and procedures of both the Physician Billing Office and Hospital Billing Office and is able to evaluate the most appropriate route for account resolution.
• Reads, interprets, and understands various differing insurance correspondence including both explanation and coordination of benefits.
• Demonstrates a basic understanding of varying different reimbursement terms across multiple payers and benefit plan types (HMO, PPO, Indemnity, HDHP) in both the Physician Billing and Hospital Billing landscape and how those terms may affect the responsible party's benefits and subsequent balance(s).
• Demonstrates a basic understanding of the standard healthcare coding methodologies, including, but not limited to CPT, HCPCS and ICD-10.
• Performs all clerical functions required to complete a request using available information and resources. Coordinates to resolve issues requiring follow- up with the appropriate team, insurance companies, attorneys' offices and other departments.
• Performs appropriate updates to insurance coverage, demographic information and contact information in patient billing system.
• Performs analysis of the responsible party's outstanding balance and provides consultative services to establish the most efficient and effective account resolution that meets the needs of the patient while also protecting the financial viability of Advocate Health.
• Prompts guarantors to pay outstanding balances over the phone using a credit or debit card, provides the lockbox mailing address for physical checks or initiates monthly payment arrangements for patients through Advocate Health's third-party partner.
• Responsible for meeting and maintaining Productivity measures and Quality Assurance goals as established by the Customer Service Department.

Physical Requirements

Work requires most of the time spent sitting, however, the work does require some walking. Work requires heavy telephone use and interaction with patients, family members, other departments, and outside sources. Requires minimal standing to file documents and do research. Must be able to reach and bend on a moderate level.

Education, Experience and Certifications

High School Diploma or GED with 2 years relevant customer service experience, or bachelor's degree preferred. 2 years progressive work experience in a hospital billing, professional billing or shared services environment preferred. Experience with Epic's Resolute Hospital or Resolute Professional billing applications preferred. Working knowledge or professional and hospital billing and follow-up preferred. Knowledge of HIPAA standards and medical terminology and billing practices preferred. Bi-lingual (Spanish and English) preferred.