Customer Account Rep

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New Haven, CT
Jan 15, 2019


Job Description

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.


Responds to a wide range of customer calls in a fast-paced call center environment and correspondence regarding third party coverage to ensure that patient accounts reflect accurate information. Directs the work of other staff members throughout the departments in order to facilitate the process and achieve resolution. Must handle an extremely heavy volume of patient calls and analyze third party information and coverage issues in order to resolve patient accounts (i.e. including eligibility periods, coverage information, etc.) provided and determines which of the patient''s accounts it applies to. Complies with all HIPPA verification procedures to ensure that you are speaking with the appropriate party prior to providing information. Takes appropriate action to resolve account balances while ensuring the Hospital''s image of good customer relations is maintained at the highest level. Researches and investigates patient inquiries in order to direct patient inquires to the correct source or follow up to resolve their issues. This involves the coordination of information from the patient, clinical areas, government agencies and insurers in or to reconcile the account. Individual should be detail-oriented and possess excellent analytical skills in order to resolve the more complex patient inquires. Must balance good customer service skills with the need to expedite calls in order to meet the heavy demands. Applies knowledge of federal and state regulations/laws including fair debt act, when attempting to collect balances or discussing other patient payment options over the telephone. Spanish speaking preferred.

  • 1. Handles a high volume of incoming calls in a call center environment regarding patient and third party information to ensure that accounts reflect accurate information and third party coverage. Determines the appropriate corrective action and takes the necessary steps to insure that the account is resolved in a timely manner while documenting all actions in the system. Coordinates the efforts of other staff members throughout the departments in order to expedite account resolution and the response to the patient.
  • 1.1 Determines the nature of the inquiry upon receiving the call as
    monitored by the supervisor.
  • 1.2 Determines immediately what course of action should be taken to resolve the problem to ensure the patient and/or customer will not receive any further correspondence until the account is investigated or resolved and notes this information in the system.
  • 1.3 Initiates paperwork necessary to correct problems or contacts individuals responsible for taking corrective action and documents in the system.
  • 1.4 Contacts third party payers or refers to appropriate individuals within twenty-four (24) hours of inquiry to verify payments or coverage in question.
  • 1.5 Contacts various departments outside of SBO on a daily basis to verify charges.
  • 1.6 Maintains active files on all inquiries received and their current status notifying the customer by phone or in writing of actions taken to resolve accounts.
  • 1.7 Records pertinent data on action sheet and contact immediately for follow-up as monitored by the supervisor.
  • 1.8 Initiates conversation with patients to arrange payment in full or installments in accordance with credit and collection policy and established guidelines, obtaining credit card payments over the telephone.
  • 1.9 Discusses Financial Assistance Programs for those who may meet the criteria and advises the patients about the process.
  • 2. Analyze the problem accounts and correspondences as it pertains to accounts and provide caller or inquirer with a seamless experience. Responds to complex mail responses not handled by Support Area, taking corrective action to ensure effective billing and facilitates the workflow in the area.
  • 2.1 Provides the documentation necessary within forty-eight (48) hours to resolve administrative complaints and notates the system.
  • 2.2 Reviews and responds to internal and external mail/data electronic mail within five (5) days of receipt.
  • 2.3 Contact individuals internal or external to the hospital to obtain information required for the resolution of the account within forty-eight (48) hours of receipt and documents in the system.
  • 2.4 Respond to patient inquiries received via e-mail.
  • 2.5 Respond to patient questions through On Line Chat by quickly and accurate responding via an open dialogue on the computer.
  • 2.6 Responds to patient complaint letters, request letters and at times, in conjunction with supervisor, determines the appropriate referral of complaints process (i.e. send copy to legal, patient advocates, nursing, etc.).
  • 2.7 Responds to Attorney requests, using the lawsuit protocol (checking authorizations) including the use of the LEAD form when Medicaid has already paid.
  • 3. Maintains and adds to personal knowledge by keeping informed of billing and payment policy updates to regulations and procedural changes and attending meetings and seminars, to effectively carry out assigned duties.
  • 3.1 Reviews all memo and policy updates as they are distributed by the supervisor, to ensure current billing procedures are followed.
  • 3.2 Keeps informed of billing and payment policies and changes in regulations as they pertain to the Third Party areas.
  • 3.3 Maintains up-to-date knowledge of Financial Assistance Program requirements as well as collection policy and procedures in order to initiate discussion of Free Care or Discounted Care Program for those who meet the criteria.
  • 3.4 Follows the T-19 Eligibility procedures for identifying self pay patients who may actually have Medicaid (this includes working the Med-Fax Report).
  • 3.5 Attends meeting and seminars as required by the supervisor.
  • 3.6 Informs supervisor of any pertinent information or problems as they arise to ensure efficient operation of the department.
  • 3.7 Performs other duties as requested by the supervisor, to maintain smooth operation of the department.
  • 3.8 Flexible within the call center hours of 7:30 a.m. to 5:30 p.m. with some weekend hours possible.
  • 4. Promotes Patient Centered Care Concept throughout the organization. Participates in work groups to analyze, identify, plan, develop and implement changes to enhance the overall performance of the department.
  • 4.1 Participates in any on-going in service training to ensure a clear understanding of departmental procedures and communicate any changes to staff as it relates to this specific service line.
  • 4.2 Attends a minimum of two courses a year offered through the Institute for Excellence in order to not only improve personal growth but also to educate and reinforce staff accountability and overall performance.
  • 4.3 Attends various service line meetings and actively participates in issue resolution and the ensuring of appropriate benefit coverage and reimbursement on accounts
  • 4.4 Utilizes Excel (or equivalent software) to develop and produce reports as needed
  • 4.5 Utilizes business office related software to produce reports necessary to manage special projects.
  • 4.6 Employee recognizes and performs duties and takes responsibility for coordinating work flow within an area as part of a special project team
  • 4.7 Employee exhibits a positive attitude as it relates to interaction with co-workers, performance of job responsibilities, and a genuine interest in the proper performance of the job.

    Other information:


    (number of years and type required to perform the position duties): High school diploma with business related courses. Associates degree preferred. Certified Customer Experience Professional (CCEP) through the Customer Service Institute of America (CSIA) or agree to obtain within 6 months of hire.


    Two years customer service experience in a fast paced customer service environment, including at least one year of experience processing healthcare claims.


    Certified Customer Experience Professional (CCEP) through the Customer Service Institute of America (CSIA) or agree to obtain within 6 months of hire.


    Strong customer service skills and ability to resolve complex problems in a quick and effective manner, demonstrated ability to develop strong relationships in order to partner with others to provide highest level of customer service. Excellent oral/written communication skills with ability to communicate complex requirements across clinical and financial disciplines. Demonstrates resourcefulness to accomplish many tasks and balances multiple priorities in a tense, highly active environment. Comprehensive PC proficiency, keyboarding and the capability to navigate various software and spreadsheet systems. Spanish speaking preferred.

    (how this position is held accountable for such as goals achievement, budget adherence, or other areas of accountability): Responsible for responding to a wide range of customer calls in a fast-paced environment with an extremely high daily call volume. Incumbent held accountable to balance exceptional customer service skills with the need to expedite calls in order to meet the heavy demands while ensuring that patient accounts reflect accurate information. Takes appropriate action in a timely manner to resolve account balances, conduct follow up on inquiries or refer issues to other parties when necessary, providing a single point of contact for patient/representative coordinating all aspects of responses. Incumbent applies knowledge of federal and state regulations/laws including fair debt act, when attempting to collect balances or discussing other patient payment options over the telephone. Advises patient of Financial Assistance Programs and initiates the process when patient meets the criteria.

    (describe planning, problem solving, decision making, creative activity, or other special factors inherent in the responsibilities of this position): Uses high level problem solving skills and diplomacy when dealing with patient issues in order to resolve more complex patient inquires. Highly organized individual with the ability to analyze data and problem solve quickly. Partners with other departments throughout the health system in order to provide patients with the highest quality of customer service and to facilitate timely and accurate responses to complex situations. Must build relationships throughout the organization to insure the cooperation of others in order to better serve patients.

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    Job Info

    Job: 1766

    Department: SBO Customer Service
    Category: Admin Support
    Status: Full Time
    Shift: DAYS
    Hours: 40.00