JOB SUMMARY

Performs tasks of moderate to difficult complexity relating to both hospital and physician accounts. Handles a large volume of inbound calls assisting patients with requests for information, complaints, and resolving issues. Responsible for making outbound calls related to self-pay follow-up on accounts. 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, and undistributed balances.

MINIMUM REQUIREMENTS

• Education - High School diploma or equivalent OR post-high school diploma / highest degree earned
• Experience - Two (2) years billing, bookkeeping, and/or accounting experience

KNOWLEDGE, SKILLS AND ABILITIES

• 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.

ESSENTIAL FUNCTIONS

• All team members are expected to be knowledgeable and compliant with Prisma Health’s values: Inspire health. Serve with compassion. Be the difference.
• 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.

SUPERVISORY/MANAGEMENT RESPONSIBILITIES

• This is a non-management job that will report to a supervisor, manager, director or executive.