Single Billing Office, Customer Service Specialist, FT, Days, - Remote

Prisma Health is dedicated to transforming healthcare for the benefit of the communities they serve. They are seeking a Customer Service Specialist to handle hospital and physician accounts, assist patients with inquiries, and resolve billing concerns while ensuring compliance with privacy and regulatory requirements.

Responsibilities:

• Performs tasks of moderate to difficult complexity relating to both hospital and physician accounts
• Handles a large volume of inbound calls
• Responsible for also making outbound calls related to self-pay follow up on accounts
• Assists patients with requests for information, complaints, and resolving issues
• Responsible for data analysis and interpretation throughout all functions of revenue cycle, to determine reasons for denials, non-payment and overpayment, post/balance/correct electronic remittances, billing and follow-up of government payers and specialized accounts, analysis/correction of correct coding guidelines, preparation of accounts for appeal, review/analysis of insurance credit balances and analysis/movement of unapplied, unidentified, undistributed balances
• Moderate to difficult levels of evaluation, analysis, decision making required in these roles
• Resolves billing concerns, addresses inquiries related to insurance concerns/matters, assist patients with MyChart while simultaneously establishing a rapport with our diverse field of patients
• Reviews accounts to determine insurance coverage; obtains and corrects any missing or inaccurate information
• Discusses patient responsibility, which includes educating patients on claim processing, deductible, coinsurance, and co-pays
• Interacts with patients by making patients aware of payment options such as payment plans and financial assistance as well as how to apply for financial assistance if circumstance warrant
• Ability to set up payment plans in MyChart based on patient's personal needs
• Greets patients in a professional and courteous manner
• Communicates clearly and professionally in both oral and written communication
• Be clear and concise in all communication to ensure patients understand the information that is being communicated to them by the Customer Service Specialist
• Maintains a high level of poise and professionalism in dealing with patients
• Knows when to escalate a patient service issue real time
• Research customer requests or issues, determines if further action is needed, forwards to appropriate party for resolution, and exercises good judgement to determine urgency of patient's need
• Contacts payer and makes hard inquiries on account status if needed
• Escalates problem accounts to the appropriate area(s)
• Documents billing activity on a patient's accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leaders
• Properly documents accounts clearly with indicators and activities so that tracking and trending can be prepared for any potential further analysis if needed
• Ensures all work is compliant with privacy, HIPAA, and regulatory requirements
• Participates in general or special assignments and attends all required training
• Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance
• Answers all incoming calls from Prisma Health patients
• Performs other duties as assigned

Requirements:

• High School diploma or equivalent OR post-high school diploma / highest degree earned
• Two (2) years billing, bookkeeping, and/or accounting experience
• Knowledgeable of the job functions required for a A/R Follow-up Representative, Cash Posting Representative, Claims Clearinghouse Representative, Correspondence Representative, Credit Processing Specialist, Denial/Appeals Specialist, Payment Research Specialist and a Quality Assurance Specialist
• Knowledgeable of the entire Revenue Cycle and Epic