Call Center Rep

Job Profile Summary

This role focuses on performing activities associated with evaluating, developing, recommending, implementing, and carrying out the policies and procedures related to the delivery of high quality patient care. In addition, this role focuses on performing the following customer service duties : Guides the patient through the healthcare system and works to overcome obstacles that are in the way of the patient receiving the care and treatment they require. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation.

Job Overview

This position functions as a key communicator. Promotes company's commitment to superior customer service. Proactively and reactively seeks appropriate solutions to potential and existing service issues. Identifies root cause issues and works diligently and cooperatively to minimize or eliminate issues leading to the successful completion of the referral. This position is responsible for the ongoing and uninterrupted flow of information through face-to-face interactions and through phone calls. Performs routine duties that require exceptional computer skills, and proper etiquette. In addition to answering inquiries, this position may be responsible for the accurate and complete collection and capture of patient registration data. Reviews and verifies scheduled ambulatory visits, confirms that valid insurance coverage exists, that a referral is authorized for specialty visits, and the accuracy of primary care physician data for all managed care patients. Provides excellent customer service to our patients to promote a positive experience.

Job Description

Minimum Qualifications :

1. High school diploma or equivalent.

2. One (1) year of customer service or call center experience working in billing, collections, or insurance.

Preferred Qualifications :

1. Associates degree.

2. Three (3) years of customer service or call center experience working in billing, collections, or insurance.

3. Bilingual

Duties and Responsibilities : The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.

1. Acts polite and courteous to patients and customers when interacting with customers and patients. Provide excellent customer service and problem solving when issues arise with either housekeeping, transport, or food service requests.

2. Answers and analyzes requests and handle as needed further research may involve interacting with area staff, supervisor, manager, another hospital departments or patient advocate office.

3. Answer calls that come in to the call center and dispatch these calls out to the appropriate service and / or staff member. Receives and transfers calls to appropriate personnel. Provides follow up calls as needed.

4. Receives and records messages in accordance with guidelines of job scope to appropriate personnel.

5. Monitors phone, fax systems, and mail inquiries for resolution. Resolve or direct returned mail to proper staff member.

6. Assists with daily operations of the including coordinating referrals and maintaining communication between referral sources, patients and the agency.

7. Obtains and / or verifies complete registration information for all patients scheduled within 48 hours of their appointment as well as for walk-in appointments.

8. Enters the treatment authorization number into the appropriate field in the Siemens system. Enters the level of referral authorization into the appropriate field.

9. Interacts with billing and collection agencies. Identify patient issues / disputes, account holds and payment plan questions and assist with resolution. Reviews and responds to denials related to wrong insurance billed, no referral / authorization and not eligible date of service.

10. Provides requested billing, demographic information to physicians, ambulance companies and other partners as requested via the telephone following hospital protocol.

11. Posts patient credit card payments as requested over the telephone to appropriate accounts via the hospital system.

12. Researches self-pay credit balances and prepare for check refunds, refund of credit card payments through current system as required or transfer payments to other open accounts per hospital procedure.

Physical Requirements :

1. Normal office environment.

2. There is little discomfort due to dust, dirt or other environmental factors.

3. Constant contact with patients, internal and external physicians, payers and managerial staff either in person or via telephone.

Skills & Abilities :

1. Strong customer service skills including excellent interpersonal and telephone skills.

2. Ability to deal effectively with upset or difficult patients.

3. High degree of tact is necessary due to frequent interaction with patients, insurance companies, and staff of all levels.

4. Understanding of medical terminology

5. Thorough knowledge and understanding of health care delivery systems with special emphasis on the referral management process for managed care providers.

6. Demonstrated organizational skills and attention to detail. Ability to perform accurate data entry.

7. Ability to communicate, read, and write in English.