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Lead Customer Service Associate

Job Details:

JOB SUMMARY:

The Lead Customer Service Associate manages the day-to-day processes of documenting and resolving patient concerns and inquiries for hospital bills and associated physician's bills.

RESPONSIBILITIES:

Customer Service

Follows up and resolves outstanding issues related to insurance questions and payments when requested .

Coordinates with other departments, physician's billing, and patient relations when necessary in order to expedite the resolution of a patient issue.

Evaluates the extent of inquiries and notifies management of potential trends in types of calls or customer complaints.

Ensures all customer inquiries and complaints related to patient accounts are resolved in a timely manner.

Monitors and resolves comment codes as required, highlighting potential trends, and escalating issues as necessary; screens for, sets up, and resolves financial assistance-Charity Care according to federal and New York State regulations.

Operates in multiple independent patient information systems to resolve potentially complex accounts.

Manages estate checks and deceased patient account resolution.

Addresses inquiries from multiple sources including attorneys, insurance companies, patients and BSHSI Centers of Excellence.

Interprets letter series to resolve patient inquiries with an advanced level of complexity.

Retrieves and interprets payment documents from insurance payers and other sources.

Ensures the appropriate revenue cycle flow to pursue patient liabilities while optimizing customer service and appropriate accounts receivable movement.

Ensures patients are aware of all financial assistance programs and coordinate with the appropriate vendor to ensure the patient receives the maximum appropriate level of assistance.

Coordinates with Billing Center of Excellence when additional patient information is gathered that may require re-billing, additional reviews, or edits to a claim.

Follows all HIPAA (Health Insurance Portability and Accountability Act) rules and regulations.

Offer patients monthly payment plans, when required, and facilitates set up with Charity's self-pay vendor.

Financial Assistance

Monitors the processing of incoming Charity Care applications.

Receives and routes Charity Care applications to appropriate staff.

Reviews Charity Care applications based on predetermined eligibility criteria if patient has been rejected from any other insurance coverage.

Calculates percentage of FPL for the approval or denial of Charity Care applications.

Communicates Charity Care status to patients.

Adjusts patient accounts per Charity Care approval.

Sends letters to the address provided on the application informing the guarantor of eligibility after a determination is completed.

Assists the System Director of Revenue Cycle with special projects and New York State audits as needed

Performs related duties as assigned.

QUALIFICATIONS / REQUIREMENTS:

Experience: 4 to 5 years of experience in Hospital Customer Service, Call Center, Billing or Follow-Up preferred.

Education: A high school diploma or equivalent required; college degree preferred

Licenses / Certifications: N/A

Other:

Overall knowledge of the operation of patient financial services, patient access, and physicians billing.

Comprehensive understanding of insurance pre-certification requirements, contract benefits, credit and collection procedures, New York Charity Care & financial assistance programs, and medical terminology.

Expertise in insurance, managed care and federal/ state coverage.

Firm understanding of complex technology systems operations to resolve patient inquires in a timely sensitive manner.



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