Patient Financial Services I - Bilingual Spanish

Raleigh,NC - USA
Position Requirements
Duties & Responsibilities:
Provide excellent customer service to customers and external business partners (Med Data and our Collections Agencies) using various forms and means of communication to appropriately respond to questions and inquiries.
1.a Provide customers and external business partners with accurate
information and account status. This requires thorough review of Med suite and Med Data Portal; review of account Notes; review of EOB's and/or any other
correspondence received and accurate assessment of new and/or revised
information provided.
1.b. Request and validate the account information necessary for billing
and claim submission. This may include primary and secondary insurance
information, patient's legal name, billing guarantor, current address,
and telephone number.
1.c Make every effort to fully resolve issues at time of the inquiry.
Escalation of accounts is appropriate only when Associate is unable to
resolve issues. Refer to department guidelines for required actions.
1.d. Handle client complaints in a professional manner following all policies and procedures. In the event a patient/parent disputes the billed amount or
validity of services, attempt a resolution; but if caller remains dissatisfied,
advise of the right to file a formal, written billing dispute in accordance
with policy/procedure.
1.f. Verify 3 separate elements of the patient account including the patient's date of birth, prior to speaking with clients.
1.g. Elevate problems or trends to the department's Management.
2. Ensure new and/or updated claims are submitted when appropriate
to the insurance carriers.
2.a. Always validate patient's legal name and secondary insurance
information including dates of birth of the respective subscribers.
2.b. Verify patient eligibility by contacting payers, and accurately update all required fields in Med suite for timely claim submission.
2.c. Always, correctly select a payer plan that represents the subscriber's insurance and financial class.
Important: Payer Plan code selection must always reflect whether the insurance is contracted Managed Care, Commercial non-par, or Government, per Master Database Contracts and/or Payer Search.
2.d. Determine whether a claim must be billed or re-billed to the primary or secondary insurance when appropriate. Decision points include (but are not limited to) whether the correct primary and/or secondary payers were
previously billed, the status of outstanding primary or secondary claims,
plan filing limits, small balance thresholds, etc.
2.e. Document all actions taken in appropriate Notes section of Med suite.
This includes but is not limited to: Calls received, outgoing calls made,
accounts worked from web portal or reports, credit cards processed, etc. Accounts not noted are considered "not worked".
3. Responsible for working Med Data related tasks as follows:
3.a. Take appropriate actions to resolve various categories of
Med Data Info Requests found in the Web Portal within 72 hours.
These include account research, notating web Portal and Med suite.
3.b. Work Accumulation reports daily (a.k.a. scrubbing reports) to
resolve any discrepancies prior to placement with Med Data.
3.c. Work daily Exception Reports generated from Med Data as instructed.
3.d. Perform analysis and work accounts generated from the
150 Day Reconciliation Report to reconcile Med suite
and Med Data.
3.e. Work Front End Reconciliation Reports to ensure daily file transmissions are successful and prevent inconsistencies between both billing systems.
3.f. Work various Med Data Queue Maintenance Reports and Med Data follow up queue in Med suite.
4. Coordination with Frost Arnett and Optima Collection Agencies.
4.a. Work various reports submitted by Collection Agencies and respond
to inquiries in a timely manner.
These include but are not limited to New Insurance Found,
Debt Verification and Disputes.
5. Adhere to all policies and procedures.
5.a. Comply with all applicable policies and training documents including (but not limited to): Patient Accounts Training Manual, Patient Disputes, Customer Service Collection Methodology, and Secure Communication/PHI.
5.b. Any patient private health information (PHI) must not be divulged on any account except to payers that need the information to process the claim for payment.
5.c. Read and comply with all established policies and procedures, both
internal and companywide, with special attention to Compliance policies.
5.d. Openly discuss weakness in policies and make suggestions
for changes to benefit the company.
5.e. Maintain constant awareness of potential safety hazards ensuring
necessary safety precautions.
6. Communicate effectively and professionally.
6.a. Communicate in an effective, business-like manner by telephone,
e-mail, fax, and in the billing systems.
6.b. When speaking with clients, employ appropriate phone etiquette
and technique including modulated tone and open, friendly demeanor.
7. Promote teamwork.
7.a. Understand the importance of teamwork internal and external
to the PFS Unit.
7.b. Work well with other co-workers (internal and companywide).
7.c Willing to help other team members with problems as well
as everyday tasks.
8. Function independently.
8.a. Able to perform daily tasks with little or no guidance.
8.b. Thoroughly troubleshoot problem accounts with limited direction
from others.
9. Professional in demeanor and interpersonal relations.
9.a. Always embody the principles of the corporate Mission Statement
and Philosophy.
9.b. Conduct all work relations on the tenets of professionalism,
mutual respect, and quality customer service.
10. Participate in quality improvement and morale building initiatives.
11. Meet or exceeds required departmental performance standards
on a consistent basis.
12. Perform other job-related duties within the job scope as requested by Management.
13. Work overtime in mandatory situations.
Job Summary:
Under direct supervision of the Patient Financial Services Manager, the Associate is responsible for effectively communicating with American Anesthesiology patients and external business partners to include Med Data and Frost and Optima Collection Agencies. Associate will provide assistance with questions, account audits/research, insurance verification, account updates and claim submissions. Associate will work on weekly Accumulations of account to Med Data. Associate will work various exclusion, exception and reconciliation reports associated with Med Data workflows as well as work within the Med Data Web Portal to resolve Info Requests. Associate will also work various Optima and Frost Collection Agency reports and provide customer service coverage for the Call Center as necessary.
Systems utilized will include the following: Med suite, Collection Agency Portal, Master Database, Med Data Web Portal, IVR, Accurint, First Class, credit card processing software such as Ipayx as well as MS Excel and Word. Position may require the use of specialized telephone equipment including digital displays, headsets, and monitoring devices.
Experience/Skill Requirements:

• Minimal physical effort
• Required lifting to twenty pounds.
• Close vision, color vision, and ability to adjust focus are required.
• Moderate noise level
• Works in a clean, well-lighted and ventilated environment with no apparent exposure to physical hazards.

Education/Certification Requirements:

• Associate degree (A. A.) or equivalent from two-year College or technical school; or one to two years related experience and/or training; or equivalent combination of education and experience.
• Ability to read, analyzes, and interprets general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to effectively present information and respond to questions from clients and the public.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to calculate figures and amounts such as discounts and percentages.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Ability to define problems collects data, establish facts, and draw valid conclusions.

EEO Statement
North American Partners in Anesthesia is an equal opportunity employer.