Job Description

North OKC Medical Billing Office looking for a full time Customer Service Specialist

Monday through Friday, no weekends or major holidays.

The Customer Service Specialist is responsible for patient support functions in the Central Billing Office. This includes, but not limited to, customer service phone calls, resolving patient complaints, research and resolving patient questions, setting up payment plans and initial screening for charity. The Customer Service Specialist also acts as the liaison between the patients, the CBO and our clients in regards to patient issues.

Essential Functions:

• Provides patient related support for the CBO according to policies and procedures.
• Effective and efficient communication, computer to include Microsoft Office Products and phone skills.
• Ability to work in a fast paced environment with frequent interruptions.
• Must understand the claim reimbursement process from the time the patient is seen until the claim is resolved in full.
• Must be able to answer questions related to the claim status whether balance is pending for third party insurance or patient responsibility.
• Must have excellent knowledge of third party payor contracts, processes and procedures.
• Must be able to analyze an insurance EOB/correspondence and explain it to a patient in a concise and clear manner.
• Must understand the CBO patient payment guidelines and the charity guidelines for each client.
• Must exercise independent judgment and be able to resolve complex account issues completing any necessary research needed.
• Responsible for correcting issues found with claims including, but not limited to, demographic and insurance changes.
• Representative must maintain a positive and highly professional working relationship with patients, physicians and staff, facilities and staff, co-workers, other departments and any other entity they may have contact with in performing their daily duties.
• Expected to stay informed and up to date on any rule or policy change in regards to their current position.
• Employee is expected to be proficient in all systems, programs and processes associated with their current position within the CBO.
• Effectively working and cooperating with supervisors, co-workers and clients.
• Following the directions of supervisors.
• Refraining from causing or contributing to disruption in the workplace.
• Regular and reliable attendance.
• Performs other duties as assigned.

Functional Accountabilities:

• Answers incoming phone calls in a prompt and courteous manner.
• Returns all telephone messages within 24 business hours with the exception of Holidays.
• Makes sure at all times that they are following HIPPA guidelines in all forms of communication.
• Answers billing questions, explains balances due, evaluates and analyzes accounts to resolve customer questions/complaints.
• Assists patients and/or guarantors with payment on account, budget arrangements and patient discounts per established CBO policies.
• Provides information including paperwork at patients request following all guidelines established by our “release of information” policies.
• Responsible for pulling needed paperwork from Onbase, archive, EMR and client contact when needed.
• Accepts payment over the phone by credit card or check by phone and sends to appropriate department for processing.
• Updates demographic and insurance data with information obtained from patients/guarantors and client staff.
• Requests re-file of claim when warranted and follows up on any additional actions needed based on new information.
• Does initial screening for charity when requested by patients and if patient meets criteria will send charity application.
• Responds to patient correspondence by phone or mail and refers to other departments for resolution when appropriate.
• CSR is responsible for contacting the client for any required information and ensures timely follow up with the client until information is received or issue is resolved.
• Forward claim issues that could not be resolved through the normal course of customer service efforts to the appropriate team or manager in a timely manner.
• All patient complaints will be communicated to the Customer Service manager so that they can be tracked and reported to the appropriate staff.
• Note clearly and precisely any and all actions taken on an account in the appropriate notes section of current system.
• All activity performed is noted on the patients account in the appropriate billing system.

What We Offer

As an organization, one way we care for our communities and each other is by providing a comprehensive benefits package that includes:

• Medical, dental, vision, and prescription coverage
• Life and AD&D coverage
• Availability of short- and long-term disability
• Flexible financial benefits including FSAs, HSAs, and Daycare FSA.
• 401(k) and access to retirement planning
• Employee Assistance Program (EAP)
• Paid holidays and vacation

Required Skills

Required Experience

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