Customer Service Representative - Revenue Cycle - Sharp Corporate - Day Shift - Full Time

Sharp HealthCare•San Diego, CA

8d•$26 - $37

About The Position

Receive, resolve, and respond to incoming and generate outbound calls, live chat and walk-in patients for inclusion in the following areas the PFS divisions of Community Care (CCD), Institutional Care (ICD), Managed Care (MC), and SharpCare (SC) in a manner reflecting the Mission, Values, and Philosophy of Sharp HealthCare. Responsible for responding to all patent and provider billing questions, concerns, and inquiries promptly, courteously, and professionally.

Requirements

2 years' experience in customer service, medical billing, patient services, member services, patient accounting or claims processing.
CRCR certification is required within 1 year of hire.
English as primary language.
Working knowledge of technical or professional medical billing practices including understanding of contract language.
Working knowledge of medical terminology, ICD procedure and diagnosis codes, CPT codes, HCPCS codes.
Working knowledge of PC functionality.
Ability to type 45WPM and basic math skills.
Strong professional level of written and oral communication skills.

Nice To Haves

H.S. Diploma or Equivalent
1 Year Experience with Automated Call Distribution (ACD) system in a call center environment.
Certified Revenue Cycle Representative (CRCR) - HFMA -PREFERRED
Certified Specialist Managed Care (CSMC) - Healthcare Financial Management Association -PREFERRED
Additional communication skills in Spanish, Tagalog, or Farsi a plus.
Clear understanding of Fair Debt and Collection Practices Act (FDCPA)-preferred.

Responsibilities

Achieve an overall departmental service level of 80% or greater. This is achieved by answering within 60 seconds or less.
A monthly outbound survey of patient feedback. Goal is to achieve an average score of 80% or higher.
Cash- Average of ICD and CCD cash collections scores CCD- Total of Customer Service, Self-Pay, and online collections ICD- Straight self-pay and self-pay after insurance.
Performance errors including but not limited to HIPAA breaches, balance/transaction adjustments, insurance, credit cards, CRRs, ARRs or failure to follow vendor guidelines (PMS, Peatman, Clear Balance, MedFi)
Handle patient inquiry in a manner consistent with department guideline at 8:31 minutes or less
The amount of work accomplished during assigned work hours, is measured by the percentage of time available to take calls when signed in to an ACD system. Demonstrates consistent call volume according to department guidelines and minimizes unproductive time and unapproved break codes.
Adherence measures the agents accuracy in following their individual daily time schedule provided by the Workforce Management Team. Consistent adherence demonstrates consideration to department needs.
Receive and resolve incoming calls for the Customer Service Department with a focus on patient experience reflecting the Mission, Values and Philosophy of Sharp HealthCare. Demonstrates exemplary customer service, conducts calls using YATE approved guidelines and scripting to ensure patient satisfaction as listed below.
Accurate account documentation, and demonstrated proficiency in system knowledge by utilizing Sharp HealthCare applications, tools and resources.
Consistently follows all HIPAA requirements, properly reviewing account to provide accurate information, and Phone Etiquette- Incorporating soft skills while educating patients with a focus on providing a courteous and personalized experience.
Accurately follows department guidelines, policies and procedures regarding payment plans and patient discounts with a focus on reducing A/R days.
Applying critical thinking skills to resolve complex billing issues. Deescalate dissatisfied callers by demonstrating empathy with a focus on service recovery.
Applying critical thinking to resolve balance with in A/R by collecting balance in full, negotiating settlements, Recurring payment plans, bank loans or financial assistance.
Verifying eligibility and benefits via One Source for commercial and government plans. Add insurance to patient account by adding the appropriate financial class code, and follow appropriate process to assure claims are submitted in an accurate and timely fashion according to payor guidelines. Review explanation of benefits to ensure accurate billing and patient responsibility.
Intradepartmental and Interdepartmental communication within the Sharp HealthCare Organization to ensure patient’s billing questions, concerns and inquiries are resolved promptly. Communication includes but is not limited to Sharp Health Plan, SRS clinics, SRS Managed Care, SCMG, SharpCare, Onsite hospital PAS staff, Onsite Business service representatives, Patient Relations, Patient Contact Center, Technical Assistance Center, etc….
External communication including but not limited to, Health Plans, Provider Offices and Sharp HealthCare Vendors.
Receive and resolve a high call volume of inbound and outbound calls via the ACD system. Expected call handling is 56 calls per day, with the expectation of handling each call within the identified AHT guidelines.
Responsibilities include answering questions from providers, health insurances and members, regarding referrals and claims for services provided to SRS HMO members at outside organizations. Representatives also provide education regarding SRS managed care processes, and services available at SRS for HMO members. Representatives also communicate any identified errors to appropriate unit (claims, claims support, eligibility, utilization management for resolution)
Obtaining the Certified Revenue Cycle Representative (CRCR) is due within 12 months from date of hire. Department management is required to track the completion and maintenance of this certification.