Customer Svc Rep

Major Responsibilities:

• Delivers an exceptional Patient Financial experience by receiving and directing the public, by telephone or other electronic means, in a professional and courteous manner, demonstrating 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 patients 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 evaluates the most appropriate route for account resolution. 
• Reads, interprets, and understands various insurance correspondence, including both explanation and coordination of benefits. 
• Demonstrates a basic understanding of reimbursement terms across multiple payers and benefit plan types (HMO, PPO, Indemnity, HDHP) in both Physician Billing and Hospital Billing, and how these affect responsible party benefits and balances. 
• Demonstrates a basic understanding of standard healthcare coding methodologies (e.g., CPT, HCPCS, ICD-10). 
• Performs all clerical functions required to complete requests using available information and resources. 
• Coordinates issue resolution with appropriate teams, insurance companies, attorneys' offices, and other departments as needed. 
• Perform updates to insurance coverage (NC/GA only), demographic, and contact information in the patient billing system. 
• Analyzes responsible party outstanding balances and provides consultative services to establish efficient account resolutions that meets patient needs while protecting Advocate Health's financial viability. 
• Prompts guarantors to pay outstanding balances by phone with a credit or debit card, provides lockbox address for checks, or initiates monthly payment arrangements.   
• Responsible for meeting and maintaining established productivity and quality assurance goal  
• Responds to and documents all patients and internal inquiries regarding hospital and professional visits in the patient billing platform as they relate to the patient financial experience. 
• Upon successful completion of the Trainee Program (approx. 6 months) including all elements listed in major responsibilities and with Supervisor recommendation, teammate may be eligible for promotion to Customer Service Representative.

Licensure, Registration, and/or Certification Required:

• None Required 

Education Required:

• ​​ High School Diploma or GED  

Experience Required:

• ​​2 years relevant customer service experience 

Knowledge, Skills & Abilities Required:

• Experience with Epic's Resolute Hospital or Resolute Professional billing applications preferred. 
• Working knowledge of professional and hospital billing and follow-up preferred. 
• Knowledge of HIPAA standards, medical terminology, and billing practices preferred. 
• Bi-lingual (Spanish and English) preferred. 

Physical Requirements and Working Conditions:

• Work primarily involves sitting, with some walking required. 
• Heavy telephone use and interaction with patients, family members, other departments, and external sources. 
• Minimal standing for filing documents and research. 
• Moderate reaching and bending necessary. 

Preferred Job Requirements:

Education:

• Associates Degree 

Experience:

• 2 years in call center, hospital billing, professional billing, or shared services environment preferred 

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.