Self-Pay/Customer Service Patient Account Representative, Senior is responsible for all collections of accounts to ensure that PFS is capturing all revenues as timely and efficiently as possible. This position requires excellent customer service communication skills with both internal and external customers. This position takes ownership of their accounts and eliminates barriers to ensure timely and correct payment including involvement with payors and upper management, when necessary. This position will have working knowledge and understanding of commercial, government and self-pay collections including other complex payment methodologies to ensure prompt and accurate reimbursement. This position must be able to utilize and understand many complex and varying State and Federal statutes and regulations, guidelines and systems, and perform the account follow-up function with all payors and government agencies to obtain maximum and correct reimbursement of accounts receivables. This position proactively works with all payors and internal resources to identify and resolve issues that hinder account payment. Applies independent judgment and knowledge to audit commercial, government and self-pay accounts as it relates to payments, denials, appeals and billing issues.
Essential Functions and Responsibilities of the Job
Ability to provide prompt and courteous customer service to all internal and external customers.
Ability to use critical thinking to research, review and follow-up on all accounts.
Ability to communicate effectively in verbal and written form.
Ability to analyze documentation and resolve patient, billing and/or collection issues appropriately and timely.
Ability to work independently with minimal supervision.
Ability to identify and analyze problems in a timely manner and independently initiates appropriate actions to resolve problems or issues.
Able to be at work and on time, follow organization rules and procedures and directions from a Coordinator/Lead or other member of the Management staff.
Adheres to all confidentiality policies and procedures and carries out all tasks in a pleasant and respectful manner.
Ability to make suggestions for enhancements throughout the department and continually seeks opportunities to improve current policies, procedures and practices.
Ability to recognize and perform essential duties and offers assistance to others or performs other required tasks when own assignments are completed. Performs other duties as assigned by management.
Ability to use critical thinking while reviewing billing and collection notes in the financial computer system to ensure that the appropriate action is taken within the billing and collection process and to ensure correct hospital reimbursement
Essential Job Outcomes
Researches and responds to patient and/or insurance inquiries timely, effectively and according to policies and procedures resulting in resolution.
At all times, provides professional and exceptional customer service when interacting with internal and external customers resulting in resolution.
Documents all communications in the financial system and updates demographics ensuring accuracy and appropriate information to move the account towards payment.
Meets productivity goals as set by Management.
Reviews and processes self-pay refunds in the financial system by insuring the refund amount is appropriate.
Uses critical thinking skills to monitor and follow-up on accounts to ensure correct hospital reimbursement in a timely and accurate manner, with minimal supervision.
Demonstrates and shares knowledge of hospital account management and collections skills with co-workers and offers assistance to co-workers, when needed.
Demonstrates appropriate, aggressive telephone and/or online follow-up as necessary to expedite payment of billed charges with minimal supervision.
Makes suggestions for enhancements within the department and seeks to improve collection efforts.
Critical handling of inbound and outbound telephone calls in a professional and timely manner.
Minimum 3 years’ experience and understanding of Self-Pay/Customer Service hospital collections processes required
Excellent interpersonal skills
Positive work ethics
Knowledge of medical terminology and coding, preferred
Written and verbal communication skills to meet productivity standards
Use of 10-key calculator by touch preferred
Microsoft Office and Outlook experience
High School diploma, GED equivalent, preferred
Business related courses, preferred
AA Degree or medical field certificate, preferred.
Internal Number: MEM003263
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.
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