Patient Financial Services I - Bilingual Spanish

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.

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