Customer Service Representative

The position of the Collections Representative is within our INR and VAD Revenue Cycle. In this role, you will handle and resolve all Insurance follow up and denial issues to ensure that company receives correct reimbursements from the insurance companies. The incumbent will serve as the liaison between insurance companies, patients and the departments to ensure the claims are processed and followed up to meet company's goals of Account Receivable Days, Aging Account percentages and Cash goals. They will also research and answer all questions and complaints, regarding patient responsibility balances and billing inquiries sent to them through the customer call center with the highest degree of courtesy and professionalism. This job description will be reviewed periodically and is subject to change by management.

Responsibilities:

• Research and resolve payment discrepancies.
• Review and manage the AR aging report and provide explanations of past due balances to management.
• Work aged accounts on assigned payers prioritizing accounts that are approaching timely filing denial.
• Identify issues or trends with accounts and provide suggestions for resolutions.
• Escalate exhausted appeals efforts for resolution with payer.
• Performs assigned Revenue Cycle duties as directed by the Revenue Cycle Supervisor.
• Able to submit a root cause analysis report.
• Prepare write off requests as needed for any uncollectable balances.
• Keeps supervisor informed of areas of concern and problems identified.
• Provide training to new and existing staff members as instructed by supervisor. Use and follow company procedures in training. Quality check work to ensure accuracy, efficiency and uniformity. Re-train staff as often as needed.
• Ensure staff complete all assigned tasks in a timely manner and that they have the resources and tools to perform their jobs. i.e. access to software. Advise supervisor immediately if they do not.
• Review/knowledge of contracts to determine correct reimbursement for each account.
• Analyze and document A/R problems and implement processes to enhance efficiencies.
• Documenting accurate and appropriate notes on corresponding systems as needed.
• Outgoing correspondence (internal or external) must be written in a clear, concise, and professional manner.
• Provide coverage as needed to include performing staff's work during their absences as assigned by management. Assist in areas of needs as assigned by supervisor.
• Maintains positive and regular results-oriented communication with payer representatives.
• Navigate and works all payer websites. Provide support to staff as needed.
• Enroll in payer newsletters and advise manager of needs.
• Initiate appeals to payers following the guidelines outlined for that payer. Note account and track appeal to resolution.
• Utilizes strong communication and customer service skills.
• Consistently practices good judgment and problem-solving skills when handling confidential information.
• Regular attendance and punctuality.

Key Results:

• Working Denials in a timely manner that results in cash collection goals.
• Represent company and team in a professional and positive manner.
• Meet and exceed daily and monthly productivity goals.
• Detailed oriented, careful and with a focus on quality in accomplishing tasks.
• Able to toggle between computer screens
• Issues identified and resolved within an average of 48 hours.
• Adapts to changing business needs, conditions, and work responsibilities.
• Effective communications with staff and management.
• Always maintain confidentiality.
• Present ideas for improvements and strategies to meet goals. Offer viable solutions to problems.
• Promote teamwork, remaining available to assist staff as needed.
• Performs any other function as required by management.
• Report to manager any non-compliance with staff as observed by you.
• Participate in personal development training and cross training as instructed by management.

Competencies required:

Behavioral Standards:

• Exhibits customer and service-oriented behaviors in everyday work interactions.
• Demonstrates a courteous and respectful attitude to internal workforce and external customers.
• Treat others with unconditional respect, dignity and equality

Communication/Knowledge:

• Provides accurate and timely written and verbal communication of information in a manner that is understood by all.
• Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.
• Able to use IT systems in an accurate and proficient manner.

Collaboration/Teamwork:

• Contributes toward effective, positive working relationships with internal and external colleagues.
• Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization

Minimum Qualification:

• High school diploma or GED required
• Associate degree preferred
• Preferred years of experience – Level I 1 to 3 years, Level II 3 to 5 years
• Excellent verbal and written communication skills, including ability to effectively communicate with internal and external customers.
• Excellent computer proficiency (MS Office – Word, Excel and Outlook)
• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
• Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices