Senior Customer Service Representative

Children's National Hospital•Pittsburgh, PA

12d•$20 - $33

About The Position

The Senior Customer Service Representative responds to parents and hospital staff regarding billing and insurance complaints involving physician and hospital services. The role facilitates the hospital’s charity process, bills special-program claims and accounts, and assists with complex billing inquiries. The representative serves as a first point of contact for billing questions and complaints, investigates and resolves account concerns, explains complex billing information, and coordinates with payors and hospital management when needed. The role also processes financial assistance applications, handles account adjustments and write-offs within established parameters, and supports timely complaint resolution and staff training.

Requirements

High school diploma or GED.
Four years of medical business office experience; the posting also describes this as 4–5 years.
Account resolution and problem-solving skills.
Ability to understand managed care contracting requirements and apply principles for assigned payors.
Understanding of federal and state billing regulations applicable to assigned payors, such as Medicaid.

Responsibilities

Serve as the first point of contact for parents’ billing complaints and questions about physician and hospital services.
Review accounts and follow up with parents until their billing concerns are resolved.
Explain complex billing information in a way parents can understand; provide account itemizations, interpret EOB letters, and provide information about legal matters when appropriately authorized.
Contact third-party payors on parents’ behalf to obtain additional information, when needed.
Research billing inquiries using internal systems and integrate information from multiple systems to respond to concerns.
Document research findings and account actions, including write-offs and documentation sent or requested.
Add insurance information to systems, as needed.
Process, record, and file Financial Assistance Program application data in a timely manner.
Review accounts and prepare adjustment forms; adjust overpayments and post account errors.
Identify complaint sources, work with hospital management to resolve issues, and refer unresolved issues to the manager.
Provide final communications to parents or hospital staff when complaints are resolved.
Assist with training customer service staff on timely account resolution to prevent complaints.
Bill DC, MD, and VA Crime Victims Claims; bill and reconcile Amish Accounts; and monitor and resolve Global Services Department Self Pay Accounts.
Ensure payments and adjustments are posted timely.
Write off account balances within identified parameters and recommend larger write-offs to the manager with supporting documentation.