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.
The Customer Experience Representative for Corporate Professional Business Services (CPBS) responds to a wide range of customer calls and correspondence regarding third party coverage to ensure that patient accounts reflect accurate information. Calls will be regarding EOBs, establishing payment plans, discussing refunds with patients, discussing balances due and specific items. Must be able to handle an extremely heavy volume of patient calls and analyzes third party information (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 information is provided to the correct party. Takes appropriate action to resolve account balances while ensuring the CPBS's image of good customer relations is maintained at the highest level. Discusses patient payment options and obtains credit card payments from patients over the telephone. Sets up payment plan arrangements for patients. Advises patient of Free Care and sliding scale options. Researches and investigates patient inquiries in order to direct them to the correct source for resolution.
Responsibilities: 1. Handles a high volume of incoming calls from patients/guarantors/families and ensures 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. Escalates unresolved billing concerns to the respective Supervisor and/or customer service unit. Maintains confidentiality of patient information, in accordance with HIPPA guidelines. Initiates conversation with patients to arrange payment in full or installments in accordance with credit and collection policy and established guidelines, obtains credit card and check payments over the telephone. Discusses Free Care and sliding scale programs for those who may meet the criteria and advises the patients about the process. 2. Analyzes accounts and correspondence and provides caller/inquirer with a seamless experience. Responds to patient complaint letters, attorney requests, and patient inquiries via email and determines the appropriate referral of complaints process taking corrective action to ensure effective billing and facilitates the workflow in the area. Reviews and responds to internal and external mail. Ensures responses/inquiries required for the resolution of the account are completed per Departmental Protocol. 3. Maintains and adds to personal knowledge by keeping informed of billing and payment policy updates to regulations and procedural changes and attends meetings and seminars, to effectively carry out assigned duties. Keeps informed of billing and payment policies and changes in regulations as they pertain to the Third Party areas. Maintains up-to-date knowledge of Free Care and sliding scale program requirements as well as collection policy and procedures in order to initiate discussion with those who meet the criteria. 4. Performs other duties as requested by the supervisor to maintain the smooth operation of the department. In addition, consistently projects a positive and professional image of CPBS. Recognizes and performs duties such as offering assistance to others when their own assignments are completed. Consistently acts in a professional manner. Exhibits a positive attitude as it relates to interaction with co-workers, performance of job responsibilities, has genuine interest in the proper performance of the job responsibilities. Answers the telephone in a pleasant and courteous manner within three (3) rings identifying the department and self as monitored by the supervisor.
High school Diploma or GED required. Associate Degree in business related field preferred.
One (1) to two (2) years' experience in healthcare revenue cycle required, including a minimum of one (1) year customer service experience. Experience in a Call Center environment a plus.
Exemplary customer service skills; analytical skills; and 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. Comprehensive PC proficiency, keyboarding and the capability to navigate various software and spreadsheet systems. Good working knowledge of third party insurance carriers (i.e. Blue Cross, Medicare, Managed Care and Indemnity) and their billing and reimbursement requirements preferred. Epic experience a plus. Spanish Speaking preferred.
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, conducts follow up on inquiries or refers issues to other parties when necessary, providing a single point of contact for patient representative coordinating all aspects of responses. Applies knowledge of federal and state regulations/laws including the Fair Debt Act, when attempting to collect balances or discussing other patient payment options over the telephone. Advises patient of Free Care and sliding scale options, initiating the process when patient meets the criteria. Ability to exercise sound judgment and act with discretion in a variety of situations as well as ensuring and maintaining sensitive information in a confidential manner, in accordance with HIPAA guidelines
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.