Consumer Service Concierge - Lead

UPMC

About The Position

The Consumer Service Concierge Lead will provide support for patients and insurance companies who initiate contact with the UPMC Consumer Service Department. This position will function as the first line of contact for the patient. The Consumer Service Concierge acts as an advocate for patients by providing guidance, interpretation, and education on billing, claim status, out-of-pocket liabilities, documentation, and various patient related inquires. Responsible for efficient, timely, accurate and courteous resolution to verbal and written inquiries while ensuring internal and external patient satisfaction, maintaining call service and quality standards and adhering to the UPMC values. Typically, functions under the direction of the Supervisor/Manager.

Requirements

HS Diploma or equivalent
1-year general customer service
6 months call center experience
6 months at UPMC as a CSC, Senior
2 years of call center experience
Act 34

Responsibilities

Answer multi-line telephone system, with a clear focus on patient satisfaction and first call resolution while reviewing and resolving patient related billing and self-pay concerns.
Redirect telephone calls and takes messages, when appropriate, interacting with the staff and leadership of other departments when necessary.
Review and verify patient's demographic, financial, and insurance information to ensure data integrity.
Enters or updates information in the appropriate system(s) accurately, verifies and revises existing information on patients.
Identify and take action to address patient concerns by utilizing effective decision-making skills to know when to handle the call, send the call to in house escalation or management staff to meet the patient’s needs.
Research, resolve and respond to email, web and telephone billing inquiries from patients and insurance carriers in accordance with departmental protocols.
Complete follow-up on unpaid account balances.
Contact guarantors, third party payors, and/or other outside agencies for payment of balances due.
Establish reasonable payment plans according to department policies; set up payment arrangement in system and monitors payments for consistency and timeliness.
Counsel patients on various local, state and federal agencies, which may be available to assist with funding of health care.
Identify and act towards resolution of problematic accounts through potential refunds, adjustments, payment transfers, etc. to bring balance to zero. Adhere to Fair Debt Collection Practices Guidelines and understands the laws and regulations applicable to job functions.
Counsel patients on UPMC options for financial assistance.
Provide financial education to patients on insurance matters.
Ensure effective communication to patients
Review and act on accounts in assigned work queues meeting specified criteria.
Document all actions taken on a patient account.
Review on-line account history and EOB's to validate the accuracy of payments and adjustments posted.
Identify, review, and research credit balance accounts, potential refunds, adjustments, payment transfers, etc., to bring the account balance to zero.
Escalate concerns within the department when appropriate.
Performs and handles patient interactions with UPMC system-wide competencies/behaviors.
Perform other duties as assigned.
Receive, investigate, respond to, and diffuse complex, escalated, high risk issues including service recovery
Special projects/assignments CRM follow-up/resolution ownership
Participate in outreach and/or conversations with internal customers/departments
Assist the Supervisor or Manager as directed
Responsible for reporting trends to Supervisor/Management
Assist in maintaining standards of work for the Consumer Service Center
Monitor and review/complete all Consumer Contact Center Epic account work queues
Train new staff as needed – all levels
Serve as Department Super Users
Serve as an employee advocate resource, troubleshooter, for the Consumer Service Center.
Represent the direction from management as a lead and is empowered to make decisions as directed.
Attend department meetings and on-going in-service and training programs.
Performs in accordance with system-wide competencies/behaviors
Performs other duties as assigned to assist the operations of the Consumer Service Center.