State of Ohio Only

Position Summary:

This senior level position maintains primary status on customer/patient service telephone and on line interaction for both hospital and physician inquiries and acts as an ambassador for the Revenue Cycle Management department providing patient centric access and service to incoming patient/family calls. The SCSRs possess comprehensive understanding of hospital and physician revenue management including coding processes, billing, insurance follow up and appropriate collection practices.  Comprehensive knowledge of internal workflow processes and vendor secondary billing support to quickly analyze and understand how to resolve incoming customer questions/ requests related to insurance, as well as patient amounts due including patient benefits for balance after insurance in a timely and accurate manner. Exceptional problems solving skills required including researching documentation and patient account history to help resolve recurring calls. Comprehensive knowledge of UH entity collection and financial assistance policies required in order to support questions /inquiries from under/uninsured patients.  Works harmoniously with staff and teams as appropriate

SCSR must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements.  System savviness and proficiency is needed across multiple financial, payer, ancillary and other applications used in documenting patient account information.  

The SCSR supports department and leadership with onboarding and training Customer Service Representatives (CSRs), act as escalation for review and resolution of difficult/complex calls to help expedite calls as well as knowledge share expertise with team mates. 

The SCSR may support call monitoring processes as part of escalation and call resolution, as well as strategy to help recommend and develop training material needed for the team to improve workflow and call resolution tactics. 

The position works closely with patients/families, staff and leadership to coordinate support and hand offs between Pre-billing/billing, Hospital Financial Counselors, Customer Service, Self-Pay Collections and Physician A/R teams to optimize patient experience and collections.   Leadership role responsible for managing secondary billing office vendor relationships and performance designed to optimize net revenue.    Works closely with RCM department leadership and staff as well as other corporate and operations department staff where research and hand offs are necessary to resolve cases accordingly.

The SCSR fully understands customer service key performance indicators and works to consistently achieve these metrics including patient satisfaction through survey submission, productivity, average speed of answer, call wait times and abandon rates setting performance standard for the department.

Essential Duties: 

 ·         Handles inbound and outbound customer calls to resolve inquires in a timely and accurate manner in a patient focused manner that enhances the experience of patients and their families.

·         Appropriately research and document all information from phone conversations and applies the appropriate transactions as appropriate to patient accounts;

·         Works with internal and external resources as appropriate to support requests needed;

·         Process payments by phone via electronic check, credit card, hard copy, payment database or any other approved means.

·         Understand, explain, execute and help determine eligibility for hospital and physician financial assistance programs.

·         Assist patients with payment plan arrangements including collecting initial down payment as part of the process by following established departmental policy.

·         Identify patient or customer needs, clarify information, research and analyze issues, and provide solutions and/or appropriate alternatives.

·         Maintains patient and physician confidentiality and professionalism in accordance with departmental and HIPPA guidelines at all times.

·         Consistently issues and helps to review and implement people, process and technology improvements as appropriate.

·         Performs various duties such as: Researching accounts, processing adjustments, refunds, and responding to patient correspondence that maximizes revenue collection.

·         Process all necessary documentation to correct patient accounts in accordance with established time frames to ensure accounts accuracy, increase revenue and promote positive public relations.

·         Monitors self-pay accounts and reviews accounts according to department policies to refer to the outside collection agencies.

·         Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.

·         Assists in the analysis of claims resolution and provides feedback to management to put in place solutions and process improvements.

·         Assists in the development of new procedures/process with a focus on improvement in quality and quantity of work performed.

·         Assists in the establishment of performance goals, monitors compliance.

·         Assists in the onboarding, training and mentoring of new and established staff.

·         Enters charges and payments in accord with established guidelines, policies and procedures.

·         Frequently resolves escalated calls and issues.

·         May assist the department supervisor/manager in weekly audits.

·         Performs other duties as assigned.

*This role may encounter Protected Health Information (PHI) as part of regular responsibilities.  UH employees must abide by all requirements to safely and securely maintain PHI for our patients.  Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace

State of Ohio Only

Position Summary:

This senior level position maintains primary status on customer/patient service telephone and on line interaction for both hospital and physician inquiries and acts as an ambassador for the Revenue Cycle Management department providing patient centric access and service to incoming patient/family calls. The SCSRs possess comprehensive understanding of hospital and physician revenue management including coding processes, billing, insurance follow up and appropriate collection practices.  Comprehensive knowledge of internal workflow processes and vendor secondary billing support to quickly analyze and understand how to resolve incoming customer questions/ requests related to insurance, as well as patient amounts due including patient benefits for balance after insurance in a timely and accurate manner. Exceptional problems solving skills required including researching documentation and patient account history to help resolve recurring calls. Comprehensive knowledge of UH entity collection and financial assistance policies required in order to support questions /inquiries from under/uninsured patients.  Works harmoniously with staff and teams as appropriate

SCSR must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements.  System savviness and proficiency is needed across multiple financial, payer, ancillary and other applications used in documenting patient account information.  

The SCSR supports department and leadership with onboarding and training Customer Service Representatives (CSRs), act as escalation for review and resolution of difficult/complex calls to help expedite calls as well as knowledge share expertise with team mates. 

The SCSR may support call monitoring processes as part of escalation and call resolution, as well as strategy to help recommend and develop training material needed for the team to improve workflow and call resolution tactics. 

The position works closely with patients/families, staff and leadership to coordinate support and hand offs between Pre-billing/billing, Hospital Financial Counselors, Customer Service, Self-Pay Collections and Physician A/R teams to optimize patient experience and collections.   Leadership role responsible for managing secondary billing office vendor relationships and performance designed to optimize net revenue.    Works closely with RCM department leadership and staff as well as other corporate and operations department staff where research and hand offs are necessary to resolve cases accordingly.

The SCSR fully understands customer service key performance indicators and works to consistently achieve these metrics including patient satisfaction through survey submission, productivity, average speed of answer, call wait times and abandon rates setting performance standard for the department.

Essential Duties: 

 ·         Handles inbound and outbound customer calls to resolve inquires in a timely and accurate manner in a patient focused manner that enhances the experience of patients and their families.

·         Appropriately research and document all information from phone conversations and applies the appropriate transactions as appropriate to patient accounts;

·         Works with internal and external resources as appropriate to support requests needed;

·         Process payments by phone via electronic check, credit card, hard copy, payment database or any other approved means.

·         Understand, explain, execute and help determine eligibility for hospital and physician financial assistance programs.

·         Assist patients with payment plan arrangements including collecting initial down payment as part of the process by following established departmental policy.

·         Identify patient or customer needs, clarify information, research and analyze issues, and provide solutions and/or appropriate alternatives.

·         Maintains patient and physician confidentiality and professionalism in accordance with departmental and HIPPA guidelines at all times.

·         Consistently issues and helps to review and implement people, process and technology improvements as appropriate.

·         Performs various duties such as: Researching accounts, processing adjustments, refunds, and responding to patient correspondence that maximizes revenue collection.

·         Process all necessary documentation to correct patient accounts in accordance with established time frames to ensure accounts accuracy, increase revenue and promote positive public relations.

·         Monitors self-pay accounts and reviews accounts according to department policies to refer to the outside collection agencies.

·         Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.

·         Assists in the analysis of claims resolution and provides feedback to management to put in place solutions and process improvements.

·         Assists in the development of new procedures/process with a focus on improvement in quality and quantity of work performed.

·         Assists in the establishment of performance goals, monitors compliance.

·         Assists in the onboarding, training and mentoring of new and established staff.

·         Enters charges and payments in accord with established guidelines, policies and procedures.

·         Frequently resolves escalated calls and issues.

·         May assist the department supervisor/manager in weekly audits.

·         Performs other duties as assigned.

*This role may encounter Protected Health Information (PHI) as part of regular responsibilities.  UH employees must abide by all requirements to safely and securely maintain PHI for our patients.  Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace

Education:

 High School diploma or equivalent required

Experience & Knowledge:

 ·         Minimum 4 year medical billing / Accounting experience required.

·         2+ year customer service phone experience working with multiple screens required.

·         Minimum 2year direct Revenue Cycle Customer Service Department experience preferred.  

·         Exceptional written and verbal communication skills

·         Advanced knowledge of medical billing and claims terminology and workflow processing.

·         Consistently demonstrates advanced analytical and problem solving skills. 

·         Exceptional client service, communication, and relationship building skills required. 

·         Advanced knowledge of claim submission (UB04/HCFA 1500) and third party payers required.

·         Self-motivated, works independently and consistently demonstrates the ability to perform with little to no supervision in a fast-paced environment.

Special Skills & Equipment Knowledge:

• Demonstrated proficiency with PCs, with HIS systems as well as Microsoft software Microsoft Office suite (including Word, Excel and Outlook), and general office equipment (i.e. printers, copy machine, FAX machine, etc.) required.
• Experience with medical billing software required.