Patient Accounting Call Center Representative

HealthPartners is hiring for a Patient Accounting Call Center Representative working in the Finance department.

QUALIFICATIONS:

REQUIRED TESTING:

Patient Accounting Terminology Test

Alpha-numeric data entry 4000

35 WPM

REQUIRED:

High School Diploma or GED

Two years recent medical billing and collection experience

One year general health care customer service experience

One year experience with automated health care billing systems

One year PC experience including Microsoft Office Suite

Knowledge of basic accounting principles

Knowledge of insurance terminology, medical coding systems (ICD & CPT) and third-party billing and reimbursement procedures

Good communication skills, written and verbal, to establish and maintain effective working relationships, with internal/external payers and customers

Demonstrated ability to work and make decisions independently, perform under deadlines and assume responsibility for problems and problem resolution

Must be detail oriented and have the ability to organize information

Must possess strong analytical and quantitative skills

Flexibility - must be able to perform team duties as required to accomplish departmental goals and meet patient customer needs

Ability to work well under pressure

Strong customer service orientation including a commitment to service and quality with both external and internal customers.

Demonstrated proficiency to maintain confidentiality and handle sensitive and confidential information, per HIPAA and HealthPartners guidelines.

Demonstrated proficiency to deliver information and answer questions in a positive manner to facilitate strong relationships with customers.

Demonstrated proficiency to adapt to new and different situations, read the behavior of others, have difficult conversations with ease, and defuse and resolve conflict.

PREFERRED:

Working knowledge of the following medical systems: Resolute EPIC

Working knowledge of billing and reimbursement policies of two or more insurance payors.

PHYSICAL REQUIREMENTS:

Ability to sit or stand for prolonged periods of time. Oral and written communications with customers requires adequate speech, vision, and hearing. Proficiency in English is required. Proficiency in other languages may be required. Use of a telephone and computer terminal also requires adequate hand writing and manual dexterity skills.

POSITION PURPOSE:

Service excellence is to be centered on patient care and patient relationships and is the responsibility of all employees. Teamwork is the norm and all employees will be held accountable to work as effective team members. The Patient Account Representative - Call Center is the primary link with the customer involving research, resolving and providing responses to patients, members, prospective members, HP personnel and third party payers on wide variety of subjects, including billing, coverage and services provided at HP. This position is accountable for responding to and resolving customer inquiries regarding billing and payment, accurate and timely resolution of claims, to include denial management, follow-up and third party collections.

ACCOUNTABILITIES:

Responsible for billing follow up/collection on assigned accounts with appropriate payers (i.e. governmental agencies, attorneys, patients, insurance companies) to ensure an acceptable level of outstanding receivables as defined by corporate or department key process measures based on national standards.

Responsible for answering an average of 800 customer service calls per month regarding payments, claims processing, coverage and billing of services provided by HP with compassion, patience, active listening and effective & efficient resolution.

Investigate, respond and resolve/facilitate resolution of all phone and written inquiries from patient/member, third party payers, and attorneys concerning billing, account status, claim status and eligibility issues.

Accountable for ensuring an acceptable level of outstanding accounts receivable, as defined by corporate or department key process measures based on national standards.

Access and understand necessary information via automated membership files, claims inquiry, account histories, account status screens. This includes understanding the systems adjudication process in determining how a claim has been paid.

Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller.

Perform maintenance as needed on the patient's insurance record to ensure accurate billing.

Demonstrating working knowledge of online payor systems in order to view eligibility and claim information on behalf of HPMG patients.

Interface with and responds to internal departments (i.e. Member Services, Claims, and HP clinics) as an information resource on billing documents (i.e. claims statements) for Fee for Service, Workers Compensation, Medicare, Medicaid, Coordination of Benefits, Third Party, No Fault, Reciprocity, Self-Insured, Pharmacy, Occupational Health as well as products provided and administered by HP and its subsidiaries.

Responsible for screening and appropriately routing misdirected patient phone calls regarding insurance benefits (i.e. copayments, deductibles, coinsurance) ,claim status (i.e. HP member services, Riverview Center, BCBS, etc.), and other inquiries not supported by Patient Accounting.

Receives, verifies, and documents patients over the phone credit card payment requests according to department procedures.

As needed, will negotiate suitable payment arrangement plans for individuals who cannot pay according to established guidelines and documents agreement according to department procedure. Accurately notes all action taken on patient's account in computer system.

Work with appropriate department/clinic/administrative staff to resolve or facilitate resolution regarding questions and/or issues related to billing, coding and denials.

Resolve walk-in patient/customer questions as necessary in a professional manner according to department procedures.

Responsible for reading and interpreting an insurance explanation of benefits (EOB)/Provider Remittance Advice (PRA).

Responsible for the understanding of insurance Coordination of Benefits and medical billing guidelines or laws.

Document accounts worked according to departmental procedures.

Keep abreast of current information and changes impacting Patient Accounting customer service and organize relevant information for daily reference.

Responsible for reading, understanding, and complying with all departmental and job-specific policies and procedures within the Department.

Re-issue claims and statements when necessary and resubmit to appropriate parties.

Act as HP wide resource for medical service fee estimates and document according to department procedures.

Responsible for knowing and understanding benefit structures provided and administered by HealthPartners, its subsidiaries, and insurance companies.

Identify and propose solutions to problems which contribute to customer dissatisfaction in order to reduce future complaints or errors.

Assist in orientation for new Patient Accounting staff. Operates as a member of Patient Accounting Team in support of other staff.

Complete assigned projects and duties in a timely manner.

Inform management/supervisor of deficiencies and erroneous items or codes in Resolute (billing system) master files.

Perform other duties as required to accomplish departmental goals and meet patient needs.