The PFS Call Center Representative serves as the hospital's primary contact for all patient billing inquiries. Acts as a liaison between Blanchard Valley Health System and patients, providers, and payers for all post-care matters related to account resolution. Provides information regarding hospital billing practices, policies, and patient billing statements. Assists patients in understanding billing statements to ensure swift resolution of outstanding balances. Fulfills the organization's mission of care and service by providing superior customer service to the patient community.
JOB DUTIES/RESPONSIBILITIES
Duty 1. Responds promptly to patient inquiries regarding hospital billing procedures, policies, and statements. Accepts inbound phone calls from patients, physician offices, insurance carriers, etc. within a specific response-to-call timeframe and with the intent to resolve the caller's concern immediately. Documents all patient accounts activities concisely, including future steps needed for resolution.
Duty 2. Follows scripts as provided by the Patient Financial Services/Revenue Cycle Leadership to facilitate consistent and expedient account resolution. While also utilizing multiple resources to resolve patient inquiries while on the phone, preparing/reviewing billing correspondence, or in person.
Duty 3. Responsible for insurance verification resulting in accurate billing and patient balances.
Duty 4. Negotiates full payment from patients and helps them set up an agreeable payment plan and/or external payment program. Collects patient payments made over the counter, over the phone, and by mail daily; properly records all payment types (e.g., cash, check, debit, credit) and transactions into the computer system.
Duty 5. Understands different payer regulations and can communicate effectively with patients regarding their Explanation of Benefits (EOB)
Duty 6. Responsible for all cashier functions when needed at the Findlay campus. Including registration, financial counseling, and banking requirements. Providing timely and accurate reporting, patient, and associate satisfaction.
Duty 7. Monitors, completes, and maintains appropriate productivity levels of assigned tasks in accordance with team standards.
Duty 8. The above duties reflect the general duties considered necessary to describe the principal functions of the job as identified and should not be considered a detailed description of all the work requirements that may be inherent to the position.
Duty 9. Remains current on collection laws, Medicare/Medicaid laws, HCAP regulations and guidelines, third party funding requirements, and adheres to all requirements for compliancy.
Duty 10. Maintains a thorough understanding and education of federal and state regulations and payer specific policies and requirements to promote compliant credit and collection practices. Adheres to HIPAA related privacy, security and transaction & code set regulations in compliance with the federal guidelines. Accurately documents all account activity. Regularly attends and actively participates in staff meetings, in-service, and continuing education programs as offered. This provides needed educational updates for compliancy and organizational changes in the healthcare industry.
Duty 11. Regularly attends and actively participates in staff meetings, training and continuing education that aligns with recognized improvement opportunities, payer policies and procedures and ensures to maintain up to date certifications. This could be remote and/or onsite as necessary, per the BVHS remote policy. Assists in other duties and projects as needed assigned by the supervisor and/or manager.
REQUIRED QUALIFICATIONS
High school graduate or GED equivalent
2-3 years of experience in medical billing and collections, or satisfactory completion of internal billing/self-pay billing assessment.
Certified Patient Financial Services Specialist certificate to be completed within 12 months of hire date.
Knowledge and experience with Microsoft office products and Window PC functionality
Excellent written and verbal communication with positive oriented interpersonal skills.
Individual must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient served on his/her assigned unit/department. The individual must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status. Must be able to interpret the appropriate information needed to identify each patient's requirements relative to their age-specific needs and to provide the care needed as described in the area's policies and procedures.
PREFERRED QUALIFICATIONS
Health administrative certification/degree or related field, and/or relevant work experience
Previous experience in a call center or "dialer" environment.
Medical terminology.
ICD 10 and/or CPT coding knowledge.
PHYSICAL DEMANDS
This position requires a full range of body motion with intermittent bending, squatting, kneeling, and twisting. The associate must be able to sit for three hours, walk for one hour and stand for two hours per day. The associate must be able to lift 20 pounds. The individual must have excellent eye/hand coordination to operate the machines. This position requires corrected vision and hearing in the normal range.
