Job Description

: Major Responsibilities:

• Acts as a resource, assists teams with more complex issues/problem resolution, and may assist in providing necessary employee training. Analyzes daily statistics to look for any trends which are reported to management.
• Answers customer inbound billing calls in a high-volume call center environment to service and retain customers. Responds to customer questions with the ability to resolve and process most concerns on the initial call.
• Accesses, understands and explains necessary information from the electronic patient billing and medical records system including claims inquiry, account history, and account status for both hospital and physician billing.
• Investigates and responds to all phone and/or written inquiries from patients/guarantors, insurance companies, physician offices, and government agencies regarding medical account billing. Makes calls to outside sources for additional information to ensure that inquiries are resolved in a timely manner with the highest degree of courtesy and a high level of patient satisfaction. Shares information following HIPAA guidelines.
• Accurately documents and updates the patient account system with all information received and all actions taken. Updates patient/guarantor demographics as needed.
• Keeps abreast of insurance sequencing rules, medical billing guidelines or laws, and changes impacting patient accounts and uses resources to validate correct process and explanation.
• Requests payment in full and processes payments using on-line system. Establishes acceptable payment plans when payment-in-full cannot be made.
• Makes appropriate patient account adjustments as necessary.
• Makes changes to patient demographics and insurance information; submits or resubmits claims to the insurance company when appropriate.
• Responds to complaints and resolves problems using established service recovery guidelines. Handles all escalated calls, attempting to resolve issues before they become escalated complaints. Works with appropriate departments to resolve questions and/or issues related to billing, coding and denials.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate, or
• Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED).

Experience Required:

• Typically requires 2 years of experience in medical billing, cash application or insurance follow up, including six months of call center experience.

Knowledge, Skills & Abilities Required:

• Knowledge of health care, insurance terminology, and medical billing.
• Ability to interpret an explanation of benefits and understand the system adjudication process and determine how a claim was paid.
• Ability to work in a high-volume call center environment.
• Excellent customer service and follow up skills.
• Ability to speak English with customers to resolve customer issues.
• Works with a variety of customers and actively listens and responds with empathy to build rapport and understanding.
• Proficient computer skills.
• Ability to perform basic math skills.
• Demonstrated ability to work well independently and as a team.
• Ability to follow and prioritize responsibilities.
• Strong multi-tasking, organizational, and time management skills.
• Ability to handle escalated calls and resolve issues before they become escalated complaints.
• Ability to represent Advocate Aurora Health and the company values to patients.
• Ability to balance all aspects of the call center's KPI's including Quality, Attendance, Adherence, Call productivity, etc.
• Ability to generate new ideas, approaches and solutions to enhance processes, practices, services and systems.
• Contributes new ideas and identifies and develops innovative ways to save time, money, effort, and resources.

Physical Requirements and Working Conditions:

• Exposed to open call center office environment.
• Must be able to sit most of the workday.
• Operates all equipment necessary to perform the job.
• Open to working remotely from your home if required.

This indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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