The Customer Service Specialist will be responsible for assisting patients with billing questions and concerns; including but not limited to: review account detail, provide financial counseling for patients having trouble paying their out of pocket expensive, review insurance correspondence and explanation of benefits, follow up with insurance companies, work closely with physician's offices and other departments of the Health System to obtain information needed for claim resolution and communicate findings to the patient.
Responsible for managing a large volume of inbound and outbound calls
Provide financial counseling for patients that are having trouble paying their out of pocket expense.
Ensure compliance with 501(r) Regulations.
Ensure compliance with all HIPAA Regulations as well as Willis-Knighton Health System privacy policies.
Resolve account problems by clarifying the patient issues, determining the cause of the problem, selecting and explaining the best solution to resolve the problem and following up to make sure the problem is resolved.
Respond to both written and telephone inquiries received from a patient concerning billing and insurance questions or concerns in a timely manner.
Review account detail, insurance correspondence and explanation of benefits to identify issues that have delayed or caused a claim not to be resolved in the manner the patient expected. Some possible causes include lack of authorization, coding issues, claim process with more out of pocket than the patient expected, etc.
Identify issues that require information or resolution from other areas of the Health System and work closely with departments to obtain corrected or additional information needed.
Works closely with physician offices and the HIM department to address denials or payment delays related to coding issues.
Provide timely feedback to the patient to let them know the cause and steps being taken to resolve their concern.
Record all conversations with patients, guarantors and insurance companies as comments on the patient account for future reference.
Compliance with the policies and procedures of the Willis-Knighton Health System Code of Conduct and service quality standards.