Customer Service Representative

Job Title: SBO Customer Service Specialist

Reports to: Director of SBO

Position Summary:

The Self-Pay Billing Office (SBO) & Customer Service unit is responsible for responding to all incoming inquiries from patients, departments, various billing agencies and other external inquiries. The representative in this team has frequent contact with patients, Patient Financial Services staff, clinic and hospital staff and management, and managers, as well as billing and professional fee and collection services vendors.

The SBO Customer Service Specialist has a thorough knowledge of WWT & UI Health insurance contracts as the unit deals regularly with complex policy and procedural issues that involve contract compliance regarding HMO, PPO and government payers. Negotiates prompt payment discounts, sets up payment plans according to departmental guidelines, and has a working knowledge of the organization’s discount and charity policy. Provides relevant information to mitigate escalation and 2nd level disputes.

This position will process all customer service inquiries and follow-ups with quality, compassion and assertiveness. Performs analysis to take appropriate action on information or documents received. Meets WWT & UI Health guidelines, government and HIPAA policies and procedures by utilizing multiple databases and applications.  Applications and Databases consist of: Epic, DataArk (McKesson), Availity, MEDI, On-BaseMS Outlook, MS Excel, MS Word, Medicare Connex, One Source and other payer websites.

Essential Duties and Responsibilities:

• Handles all customer service in-bound call queues for collections, payments, and disputes
• Ensure service levels are met and abandonment rates and RONAs are kept to a min.
• Answers patient concerns regarding the balance inquiries, itemized bill requests and questions about their statements.
• Assist patients with understanding their balance of statements and provide the available payment option that best suits their needs.
• Provides first level financial assistance screening for patients that may qualify for Medicaid coverage or charity care including creating cases for FCMU follow up.
• Updating patient demographics such insurance coverage, address, employer or covered member information.
• Prepares accounts for resubmission of claims to insurance payers when applicable.
• Initiates, route and follow-up on patient disputes regarding charges or coding issues based on workflows.
• Ensures accurate billing practices on patient accounts were applied
• Resolves operational statement hold reasons such as missing address or zip code, credit balances, unbilled coverages, etc.