Billing Customer Service Representative

TPIRC and FAI•Long Beach, CA

15h•Onsite

About The Position

We are currently seeking a Billing Customer Service Representative (CSR) who will be responsible for the daily activities associated with patient billing inquiries and related patient concerns at TPIRC. This role works directly with patients, insurance companies, financial counselors, scheduling, business office, vendors, and clinical departments to ensure all records are up-to-date, compliant with billing and coding guidelines, and consistent. This individual is responsible for providing resolution to patient inquiries and/or grievances related to all aspects of the medical billing process. The Senior Billing Customer Service Representative will demonstrate knowledge in all areas of the medical billing process and will serve as the Patient Resolution expert for the organization.

Requirements

High School diploma or GED required
Customer Service experience required
3+ years of experience in medical billing required
3+ years of experience in a specialty group practice
Comfortable navigating across various computer systems to locate critical information.
Knowledge of insurance policies/guidelines, EOB (Explanation of Benefits), prior authorization/referral processes, medical terminology, CPT/ICD/HCPCS coding preferred.
Experience with a CMS-1500 claim form.
Experience working with clearinghouses for the purpose of claim submissions.
Experience with payor portals and affiliates.
Experience with EMR and PM systems (Athena, AdvancedMD a plus)
Must have strong analytical skills, proficient with spreadsheets
Knowledge of health networks, IPA, HMO, PPO and contract affiliations.
Exceptional organizational, presentation, and communication skills, both verbal and written.
Proficiency in meeting deadlines and prioritize workload.
Ability to work independently, with direction, and as part of a team.
Experience with Microsoft Office Suite
Self-motivated, team-oriented, very responsible, and focused on exceeding customer expectations.

Nice To Haves

Medical billing and coding certification preferred.
Experience using Salesforce a plus

Responsibilities

Assist with inquiries related to invoices, statements, claims, insurance eligibility, benefits, authorizations, coding, collections, balance variances and payments providing patient resolution to inquiries.
Participate in relationship management activities with guarantors, vendors, payors and internal departments.
Handle a high volume of incoming customer service calls and tickets.
Handle verbal and written inquires, respond to and follow-up accordingly, to the point of final resolution.
Communicate clearly to identify issues and concerns - using active listening to understand the root cause.
Investigates, through coordination with the Call Center and other areas involved in the scheduling of services, providing the services, coding, processing the claim and final billing.
Makes recommendations for any adjustments to outstanding bills and upon approval processes related adjustments timely.
Communicates findings to internal areas and/or to the guarantor directly - communication is on incoming/outgoing phone lines, email, fax, mail, and tickets.
Promptly act on escalated issues: identify, investigate, and coordinate any billing corrections.
Reconcile patient accounts ensuring accuracy and ease of understanding for guarantor or authorized patient advocate.
Communicates with and educates the responsible party on the nature of billing and options for payment, including types of payment, payment plan, financial assistance and prompt pay options
Able to manage and de-escalate calls.
Ensures customer satisfaction and promote a positive corporate public image.
Maintain ethical and professional standards.
Maintain individual productivity and performance standards.
Performs job duties with oversight.
Other duties as assigned.
Responsible for coordinating the timely submission of professional medical claims to various payors.
Responsible for coordinating the timely submission of secondary claims via electronic and/or paper claim submission.
Responsible for coordinating and/or submitting claims with required documents, per payor guidelines or as requested (i.e., medical records).
Review patient statements for accuracy and completeness.
Maintain a current understanding of local coverage determinations, payor and coding guidelines to ensure claims are consistently billed properly.
Keep abreast with medical coding updates.
Maintain confidentiality and is knowledgeable of AMA CPT, HCPCS, and ICD codes and HIPPA guidelines.
Ensure patient and insurance demographics is accurate.
Ensure appropriate authorization or referral numbers are on the claim.
Perform eligibility and benefits inquiries for both new and established patients, as needed.
Enter and make the appropriate changes in the EMR/PM system(s) and Salesforce regarding guarantor, payor, insurance eligibility and benefits coverage.
Determine and update copayment, coinsurance, deductible, and out-of-pocket amounts.
Verify eligibility and benefits using a real-time system response, through health plan portals, and/or via telephone to the health plan and/or guarantor.
Responsible for verifying COB information and communicating with the health plan and/or guarantor, and/or internal departments.
Coordinate supporting documentation as needed to health plans or referring providers.
Proficient with turnaround time compliance in all aspects of the prior authorization process.
Enter and make the appropriate changes in the EMR/PM system(s) and Salesforce regarding referral/authorization status.
Coordinate request for continuity of care
Document instructions for the clinical team in the EMR/PM system(s) and Salesforce.
Coordinate resolution of referral and authorization tickets via Salesforce.
Coordinate resolution of emails and phone calls related to referral and authorizations.
Maximize revenue by coordinating appropriate follow-up and document actions taken.
Ability to read and interpret an explanation of benefits.
Knowledge of a CMS-1500 claim form and field requirements.
Monitor and maintain revenue integrity through appropriate account adjustments, small balance write-off and payment reconciliations.
Reconcile customer disputes as they pertain to payment of outstanding balances.
Respond to correspondence timely.
Coordinate resolution of credit balances and refunds.
Document instructions for the RCM team in the EMR/PM system(s) and Salesforce.
Coordinate resolution of patient statement and claim tickets via Salesforce.
Coordinate resolution of emails and phone calls related to patient statements and claims.
Ensure proper adjustment transaction codes to write-offs and denials are posted.
Coordinate research and request missing explanation of benefits or remittance advice.
Work directly with the Finance and Billing/Collections teams to ensure accurate and timely posting, both electronically and manually, with daily reconciliation.
Verifies and researches payment information and enters adjustments as necessary to ensure proper filing of supplemental claims to insurance companies and accurate patient statements.
Coordinate approved refunds.
Monitor and maintain revenue integrity through appropriate account adjustments, small balance write-off and payment reconciliations.
Consistent application of financial policies and payment processing procedures and adherence to internal controls in conformity with generally accepted accounting principles is required.
Follow all end of month and year-end expectations and guidelines.
Maintain required payment records, reports, and files.
Collaborate with patients or customers, third party institutions and other team members to research and resolve billing inconsistencies and errors.
Collect and maintain patient demographic and medical information required for medical billing.
Ensure patient documentation is scanned and filed correctly within the Electronic Medical Record (EMR.)
Provide exceptional customer service.
Maintain and understand various medical billing software platforms.
Navigate insurance websites and answers customer inquiries.
Understand office visit fees including procedure and diagnosis codes.
Maintain confidentiality and adhere to HIPAA regulations.
Complete assigned tickets as required.
Adhere to policies and procedures, update of forms and manuals.
Assist in development and communication of SOP for key areas to improve accuracy and understanding of processes.
Support daily, weekly, and monthly medical billing metrics.
Identify issues and present possible solutions and/or suggestions to management.
Interfaces with other departments to resolve medical billing workflows.
Assist other staff and support the team approach.
Communicate appropriately and clearly to management, co-workers, and physicians.
Maintain all reference material that is provided by the supervisor, manager, or director.
Know and follow the Employee Handbook policies and procedures.
Maintain patient confidentiality so that HIPAA compliance is always observed.
Demonstrate honesty and integrity in everyday activities.
Arrive to work on time.
Consistently be at work.
Willingness to work overtime when requested.