The Reimbursement Resource Representative-CSR is responsible to provide support to patients, providers and customers internally and externally on billing related inquiries. The employee works insurance claims and patient accounts using department guidelines and MPG electronic systems. The position requires a thorough knowledge of insurance carrier billing and reimbursement, CPT, modifiers and fee schedule differences. Also requires understanding of how to decipher explanation of benefits and explain the impact to the customer. Position requires the ability to conduct both telephone and face to face meetings with patients regarding account resolution and payment collection as well as via portal messaging. Assist customers with hardship applications, payment plans and eligibility for services. Expert verbal communication, interpersonal skills and professional appearance required for dealing with customers.
Essential Duties and Responsibilitiesinclude the following. Other duties may be assigned.
- Demonstrates excellent interpersonal skills with patients, coworkers and insurance carriers.
- Ensures the protection of patient information from unauthorized inquiries and is well-versed with all HIPPA Guidelines.
- Processes and posts payments to accounts same day.
- Resolves patient complaints within a minimal timeframe, same day whenever possible.
- Meets timelines for reprocessing Athena claims after updating the account with new information as provided by patients or physicians within the guidelines and timeframes permitted by the insurance carrier.
- Maintains advanced knowledge of cpt and modifiers.
- Answers phones & returns voicemails within same day.
- Maintains knowledge of Claim adjudication carrier rules.
- Conducts themselves in accordance with MPG Policies and Procedures including the Code of Conduct.
- Meets or Exceeds monthly performance goals, expectations and reviews.
- Uses Paid Time Off effectively.
- Keeps overtime to a minimum/has any overtime approved by Manager.
- Communicates call trends to managements when needed for possible escalation.
- Actively participates in team meetings and educational opportunities.
This job has no supervisory responsibilities.
Education and/or Experience
Associate's degree or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience. Experience working in health care and insurance Industry and thorough knowledge of insurance carrier billing and reimbursement, CPT, modifiers and fee schedule differences required.