Healthcare Customer Service Representative

Wolcott, Wood and Taylor•Chicago, IL

About The Position

The SBO Customer Service Specialist works in the Self-Pay Billing Office (SBO) and Customer Service unit, responding to inquiries from patients, departments, billing agencies, and other external parties. The role regularly interacts with patients, Patient Financial Services staff, clinic and hospital staff and management, and billing, professional-fee, and collection-services vendors. It requires thorough knowledge of WWT and UI Health insurance contracts and the ability to address complex policy and procedural issues involving HMO, PPO, and government payer contract compliance. The specialist negotiates prompt-payment discounts, sets up payment plans according to departmental guidelines, and applies knowledge of discount and charity policies. The role provides information to help mitigate escalations and second-level disputes, and processes inquiries and follow-ups with quality, compassion, and assertiveness. It analyzes information and documents to determine appropriate action and follows organizational, government, and HIPAA policies and procedures while using multiple applications and databases, including Epic, DataArk (McKesson), Availity, MEDI, On-Base, MS Outlook, MS Excel, MS Word, Medicare Connex, One Source, and payer websites.

Requirements

Previous call-center or medical-field customer-service experience is required.
High school diploma or equivalent is required.
Experience demonstrating expert-level knowledge of analyzing and resolving complex problems quickly and effectively.
Ability to analyze and interpret data and demonstrate problem-solving skills and initiative.
Ability to communicate effectively with patients and staff, use proper telephone techniques and etiquette, and interact sensitively across cultural differences.
Ability to provide positive, supportive interactions with patients, families, and colleagues and demonstrate teamwork by acknowledging colleagues and modeling organizational standards.
In-depth understanding of billing procedures used in hospital and professional billing and insurance follow-up.
Working knowledge of insurance billing requirements, UB-04 and HCFA 1500 claim forms, EOBs, Workers’ Compensation, Personal Injury, HMOs, PPOs, MCOs, Medicare, Medicaid, and compliance-program regulations.
Basic understanding of CPT, ICD, DRG, and HCPC codes.
Excellent interpersonal, verbal, and written communication skills.
Ability to demonstrate cultural sensitivity and maintain a respectful, courteous, and professional manner.
Ability to balance assertiveness with compassion, empathy, and patience.
Ability to handle difficult customer situations by phone and de-escalate them effectively.
Critical thinking and sound judgment in decision-making.
Good analytical and organizational skills.
Motivation, a positive outlook, and a strong work ethic.
Ability to consistently follow direction, processes, and written procedures.
Thorough knowledge of computer operation, keyboard functions, and calculator, copier, and fax-machine operation, with standard keyboard skills.
Computer software skills, including Microsoft applications and email.
Thorough understanding of HIPAA rules and regulations.
Self-starter with a strong sense of ownership, assertive follow-through, and results orientation.

Nice To Haves

Working knowledge of Epic.
Bilingual Spanish-speaking ability.

Responsibilities

Handle inbound customer-service call queues for collections, payments, and disputes, while meeting service levels and minimizing abandonment rates and RONAs.
Respond to patient questions and concerns about account balances, itemized bills, and statements; explain balances and payment options.
Conduct initial financial-assistance screening for patients who may qualify for Medicaid or charity care, including creating cases for FCMU follow-up.
Update patient demographics, including insurance coverage, address, employer, and covered-member information.
Prepare accounts for claim resubmission to insurance payers when applicable.
Initiate, route, and follow up on patient disputes about charges or coding issues according to established workflows.
Ensure accurate billing practices are applied to patient accounts.
Resolve operational statement-hold reasons, such as missing address or ZIP code, credit balances, and unbilled coverage.
Research and resolve at least 25 accounts or guarantor accounts daily from work queues for DNBI, financial-assistance screening, coverage changes, and related matters.
Respond to patient inquiries and concerns received by telephone or mail within 48 hours and no later than 30 days after receipt.
Clarify the inquiry or concern, determine and initiate or complete appropriate action, resolve complaints, and provide customer-service recovery when needed.
Research and process accounts subject to bankruptcy regulations or legal actions.
Run individual time-log reports to support effective time management and efficiency.
Perform other duties as assigned.