Customer Service Representative

Location: Shamokin, PA 17872

Job description:

This position is responsible for maintaining a timely revenue cycle and ensures accurate payment for goods and services according to contracted rates and/or payor fee schedules. Also responsible for maintaining patient confidentiality and function within the guidelines of HIPAA.

Job Duties

Accounts Receivable:

Collect on accounts by sending bills or following up on bills with payers via phone, email, fax, mail, or websites.
Investigate and resolve customer inquiries regarding charges.
Monitor patient account details for non-payments, delayed payments, and other irregularities.
Communicate with customers regarding insurance, payments, and invoices.

Authorization and Confirmation:

Collaborates with internal & external customers to provide status updates & coordinate appeals on denied authorization.
Resolves pending revenue by reconciling approved authorizations and pending charges.
Ensure orders will bill correctly to insurance.

Data Support:

Responsible for the daily claims submissions/printing for all eligible/ready status claims
Resolves all claim rejections in a timely manner to guarantee submission within the timely filing requirements of the payers.

Unbilled Revenue:

Analyze documentation required for billing services and ensure compliance to payer requirements.
Resolve pending revenue by reconciling received documentation and pending charges.
Requests authorization from state Medicaid programs.
Maintains and updates physician databases to ensure accurate delivery of billing documentation and communications with physician offices.
Completes accurate documentation of authorization request and follow up activities on each account.

Patient Financial Services

Identify trends and root causes related to inaccurate private pay billing, and report to manager while resolving account errors.
Investigate escalated customer billing inquiries and take appropriate action to resolve the account.
Respond to Collection agency regarding patient disputes of balances owed on accounts.

All RCM Specialist responsibilities:

Educate patients, staff and providers regarding authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance changes or trends
Maintains an extensive knowledge of different types of payer coverage, insurance policies, payer guidelines and payer contracts ensure accurate billing and timely payment is received.
Responsible for entering data in an accurate manner, into database including although not limited to payer, authorization requirements, coverage limitations and status of any requalification.
Performs other related duties as assigned.

Competency, Skills and Abilities:

Analytical and problem-solving skills with attention to detail.
Strong verbal and written communication.
Excellent customer service skills.
Proficient computer skills and knowledge of Microsoft Office.
Ability to prioritize and manage multiple tasks.
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.

Requirements

Minimum Job Qualifications: