Customer Care Specialist II

Overview

Job Summary

Responsible for daily customer inquiries from internal and external customers to completion. Responsible for the daily completion of both claims edit, denial, and no response billing functions for timely follow up. Handles internal and external questions to completion. Understands both paper and electronic claims as well as client invoice billing. Responsible for follow up on Accounts Receivable to all payers. Serves as a resource for other Office staff and patients concerning expected payments, payments made and contract conflicts. Performs other duties as assigned.

Responsibilities

• Handles telephone communication with patients, insurance companies and other BMG/BMHCC personnel.
• Bills, collects and submits all insurance and TPA claims according to payer guidelines, and established procedures and workflows.
• Works all insurance denials, via paper and/or electronic in work queues with patient on phone.
• Reviews accounts for possible assignment to BD.
• Reviews and sets up payment plans as requested by patient.
• Reviews and processes adjustments as needed to resolve credit balances and ensure account balances are correct.
• Communicates with Insurance companies.
• Reviews accounts for accuracy.
• Reviews items directed to Customer Service through MyChart communications.
• Reviews self-pay accounts forwarded to Customer Service by collection vendors.
• Completes assigned goals

Specifications

Experience

Minimum Required

• Business related clerical job skills including keyboarding. One year of insurance follow up or billing experience. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. Possess the organizational skills to manage and prioritize a multi-task position. Possess interpersonal skills necessary to successfully interact with clients and Company staff. Must maintain telephone and personal etiquette to effectively deal with clients, vendors, peers and management even under stressful conditions.

Preferred/Desired

• Preferred clerical skills with a working knowledge of accounting and insurance coverages and three (3) years' experience in a physician's office or hospital business setting. Good customer service skills are a requirement.

Education

Minimum Required

• High School Dipolma or GED

Preferred/Desired

• Ability to read, write and perform mathematical calculations, user of proper composition, grammar, oral communication and spelling as normally acquired by official completion of high school and/or its equivalent. Knowledge of general office techniques as normally acquired through two years of experience in credit and collections. Some College or Associate degree desired.

Training

Minimum Required

• PC skills and keyboarding and able to interact with others is required. Working knowledge of 10 key, typing and computers.

Preferred/Desired

• Prefer knowledge of insurance billing and collections and insurance guidelines. Microsoft Office and Outlook with some medical terminology and customer service skills.

Special Skills

Minimum Required

• Ability to type and/or key accurately, problem solving, written and oral communication skills, financial counseling skills, knowledge of insurance billing (both hospital and professional settings) and collections, knowledge of insurance guidelines as it relates to CMS guidelines, TennCare and/or Medicaid based by state specified requirements. Ability to recognize and communicate to clinical staff or designee when insurance companies require additional review because of NCCI, CCI , LMRP, Mutually Exclusive and Medical Necessity edits. Effective Verbal, written and customer service skills as it relates to patients and insurance companies. Able to create communications to patients and insurance companies as needed to resolve issues to complete billing/claim processes. Ability to work in a high stress environment. Ability to collaborate and cooperate with others for the best possible outcomes - promote Teamwork. Ability to prioritize and multi task.

Preferred/Desired

• Knowledge of ICD-9, ICD-10, CPT and HCPCS codes and certification and/or degree in Healthcare Administration Business, Finance or related fields preferred.

Licensure

Minimum Required

Preferred/Desired