Patient Contact Center Representative - Insurance Recovery Specialist - CPAR CPC or CPB Certification REQUIRED - Mon - Fri 8:00am - 5:00pm - Remote

Job Description:

This position answers incoming calls in a high volume call center related to facility and professional services in an efficient, friendly, courteous, tactful, calm and helpful manner. Pursues complete patient collection activities, including payment plans and financial assistance screening, prior to referring accounts to bad debt agency. Additionally, this position deescalates, researches and resolves patient complaints and questions in a timely manner, escalating to leadership as appropriate, and keeping patient informed of progress throughout process. Researches and resolves patient credit balances, undistributed payments and payment and adjustment discrepancies as appropriate. Manages institutional billing and collections, including balance and payment inquiries, issue research and resolution, and payment collection. Reviews accounts for previous billing and collection activities and appropriately pursues corrective actions when errors or gaps identified. Maintains clear and concise documentation of collection and billing correction and/or clarification activities. Serves as governmental and managed care expert for Northeast Georgia Payment Center, pursuing underpayments and denial recovery for aged balances after efforts have been exhausted by billing, follow-up and denial teams, and assisting patient in meeting payer requirements for claims (re)adjudication.

Minimum Job Qualifications

• Licensure or other certifications: Certified Patient Account Representative (CPAR).

• Educational Requirements: High School Diploma or GED.

• Minimum Experience: At least two (2) years experience in patient and insurance collections and customer service for facility and/or professional billing.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements: Two (2) years of college or Business School.

• Preferred Experience: Call center experience.

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Knowledge of Revenue Cycle functions, including registration, coding/charge posting, payment posting, and financial assistance

• Thorough knowledge of patient collection procedures and regulations

• Thorough knowledge of governmental and commercial billing and denial follow-up guidelines and UB04 and HCFA/1500 data

• Thorough knowledge of Explanation of Benefits (EOBs) to resolve any posting or billing issues

• Personal computer proficiency to include all programs necessary to perform job duties and ability to toggle between systems efficiently

• Excellent listening and problem-solving skills with attention to details

• Excellent customer service skills and ability to remain calm and professional in stressful situations

• Excellent verbal and written communication skills

• Ability to work independently within guidelines

• Telephone proficiency

• Thorough knowledge of HIPAA regulations to protect patient health information

• Certified Revenue Cycle Representative (CRCR)

Essential Tasks and Responsibilities

• Accepts all calls via the ACD (Automated Call Delivery) lines in a manner that keeps wait times to a minimum. Identifies self by name and department, handles call in professional manner, asks if all issues resolved and if anything else may be needed prior to ending call.

• Performs patient billing and collection activities on outstanding patient balance from day 1-180 (first bad debt placement), offering payment arrangements per guidelines when patient unable to pay in full, for all services performed at any NGHS affiliate -- NGMC facilities, Hospice, Long-term Care, and NGPG and THC Centers.

• Reviews accounts thoroughly, verifying balance to be correct. Performs required action to correct balances found to be in error. Uses appropriate standard work to refer errors for assistance when appropriate.

• Updates patient and guarantor records to correct errors and maintain up-to-date mailing and phone information.

• Verifies and updates patient insurance coverage. Rebills claims as appropriate.

• Escalates issues to department leadership following standard work guidelines.

• Documents and uses appropriate disposition codes in system for every account, including any action taken in order to allow for trending and process improvement as well as continuity of customer service, which may include presentation in court.

• Researches and resolves patient credit balances, undistributed payments and payment and adjustment discrepancies as appropriate, including refund processing.

• Meets or exceeds required quality, productivity and collection performance standards as determined by SPRC leadership.

• Follows required collection processes in a professional, respectful, and compliant manner.

• Follows all department and NGHS guidelines, policies, and standard work.

• Provides resolution to patient calls, emails/electronic messages and/or walk-ins based on established standards and procedures.

• Attends all Weekly/Monthly/Quarterly/Annual department and Team Meetings (unless has an excused absence).

• Serves as a positive role model to all staff members, physicians, patients and visitors.

• Remains in good standing with all NGHS policies including those related to attendance, positive attitude, and staff development.

• Works with patient/guarantor to find/add insurance, third-party sponsorship, settlement, or to begin financial assistance process. Responsible for following standard work guidelines in forwarding information appropriately for follow-up.

• Follows scripting guidelines outlined by Supervisor/Manager when interacting with patients to maintain high quality of service. Listens and thinks critically to make sound judgments on patient accounts.

• Maintains an understanding of health insurance and EOB's, collection processes and techniques, and NGHS Financial Assistance Programs.

• Adapts to frequently changing atmosphere including organizational and technological changes.

• Performs other duties as assigned, including but not limited to work queues, bankruptcies, itemized statement requests, providing Detail Bills, 1500s and UBs; and assisting with email requests and follow-up on defaulted internal and external payment plans.

• Promotes and contributes positively to the teamwork of the department by assisting coworkers, contributing ideas and problem-solving with co-workers and helps identify trends affecting patient billing and customer satisfaction.

• Thoroughly reviews all billing and collection activities performed prior to transfer to patient for all services performed at any NGHS affiliate -- NGMC facilities, Hospice, Long-term Care, and NGPG and THC Centers.

• Researches and resolves all patient inquiries and issues in a timely manner, keeping patient informed of progress when other departments must be engaged for resolution.

• Deescalates patient complaints to repair patient's billing experience. Escalates to leadership when appropriate.

• Acts as patient liaison with payer to resolve insurance billing questions and issues after the balance has been assigned to the patient.

• Analyzes all details of EOB for accuracy and resolves all insurance questions including payment, adjustments and benefits.

• Contacts patients and/or responsible parties to inform them of documents or information needed for insurance to process claim for payment.

• Contacts insurance companies via telephone and websites to reprocess aged facility and professional claims.

• Identifies and corrects posting errors and underpayments or denials that are still within the appeal window, resubmitting claims for late charges and other issues.

• Performs billing, collection and research activities for institutional (non-patient) billing and collections, including NGHS HealthLink laboratory services and other client services, providing excellent and prompt customer service and issue resolution in order to facilitate payment collection.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Heavy, Constantly 66-100% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Constantly 66-100%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding