Customer Care Specialist

JOB PURPOSE: The customer care specialist is responsible for ensuring excellent customer satisfaction through timely, accurate, and professional follow-up and resolution to customer complaints, issues, and general inquiries. Identification, validation and assignment of patient medical insurance for healthcare claims.    

JOB FUNCTIONS:

• Provide exceptional customer service and support to patients and providers
• Assist patients with understanding their statements and resolution of billing issues
• Establish payment arrangements and process payments over the phone and in person
• Identify and gather new insurance information, which includes screening for charity, answering patient’s questions, and resolving any of the patient’s account issues
• Accurate verification of all insurance eligibility through payer portals, and entry of new or updated insurance information for all patient accounts
• Analyze patient insurance(s), identifies the correct insurance plan, and documents the correct insurance order
• Responsible for ensuring billed charges are allowable per payer policies
• Initiates outreach to patients to validate incomplete insurance information
• Demonstrate full understanding of EOBs to ensure accurate patient communication
• Work task queue assignment within the practice management system
• Handle inbound and outbound customer service calls regarding billing inquiries
• Responsible for validating referrals and authorizations for procedures and services, as required
• Retrieve required patient demographics and other data from all facilities for input into the practice management system
• Maneuver between software systems
• Review and distribute incoming correspondence 
• Maintain accurate records of customer interactions and transactions
• Document clear, concise, and complete follow-up notes in system for each account worked
• Partner with other billing and practice site staff to resolve complex matters
• Assist in the development and ongoing assessment of policies and procedures
• Meet department standards for both production and quality
• Immediately identify and communicate problems to team members and management
• Attend monthly meetings to keep abreast of policy changes and billing department issues
• Other duties as assigned

Education:

• High school diploma or equivalent, with additional specialized training

Experience:

• Minimum four (4) years of customer service experience using a computerized accounts receivable system in a medical or hospital setting performing billing functions
• Minimum two (2) years of experience utilizing insurance payer portals
• Experience in handling confidential data, patient demographic information

PERFORMANCE REQUIREMENTS:

Knowledge:

• Knowledge of common insurance plans (i.e. HMO, PPO, Medicare, Medi-Cal)
• Basic Microsoft Excel and Word knowledge
• Knowledge of medical insurance and authorization process
• Basic CPT-4 and ICD-10 knowledge preferred

Skills:

• Bilingual in Spanish required
• Excellent organization and time management skills
• Strong verbal and written communication skills
• Attention to detail and ability to handle sensitive information

Abilities:

• Ability to remain focused and productive each day as tasks may be repetitive 
• Ability to effectively work and communicate with coworkers, patients, and outside agencies
• Ability to present oneself in a courteous and professional manner at all times
• Ability to prioritize multiple tasks in a busy work environment
• Ability to work independently as well as in a team-based environment 

Physical Requirements:

• Involves sitting approximately 80 percent of the day, walking or standing the remainder. Some bending, stooping, and lifting up to 25 pounds.

Equipment Operated:

• Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment:

• Position in a well-lit, well-ventilated office environment. Frequent contact with a variety of people.

Safety:

• All employees are responsible for complying with safe and healthful work practices as outlined in the Company’s Employee Safety and Injury and Illness Prevention Program and policies and procedures specific to their department needs.