Catholic Health Initiatives Clinic Customer Service Rep – Revenue Cycle – Days in OMAHA, Nebraska

Clinic Customer Service Rep – Revenue Cycle – Days

Description

CHI Health is a regional health network with a unified mission: nurturing the healing ministry of the Church while creating healthier communities. Headquartered in Omaha, the combined organization consists of 15 hospitals, two stand-alone behavioral health facilities and more than 150 employed physician practice locations in Nebraska and southwestern Iowa. More than 12,000 employees comprise the workforce of this network that includes 2,820 licensed beds and serves as the primary teaching partner of Creighton University’s health sciences schools. In fiscal year 2014, the organization provided a combined $149.3 million in quantified community benefit including services for the poor, free clinics, education and research. With locations stretching from Kearney, Neb. to Missouri Valley, Iowa, the health network is the largest in Nebraska and serves residents of Nebraska and southwest Iowa. For more information, visit online at CHIhealth.com .

ESSENTIAL JOB RESPONSIBILITIES

Receives and responds in a timely and professional manner to all billing-related questions posed by clinic staff; serves as liaison with various Revenue Cycle teams and other departments to respond to, or initiate response to, clinic questions.

  • Fields incoming call and email volumes from patients and Clinics in organized manner, addressing individual clinic concerns with attentiveness.

  • Explains various billing issues affecting reimbursement, including billing edits, reimbursement methodology, denial trends, and payer regulations or requirements to clinic representatives.

  • Provides feedback and training to clinic staff based on examples and/or trends identified in the Revenue Cycle, as necessary.

  • Applies knowledge of CMS and other insurance billing guidelines and regulations, payer contracts and reimbursement as well as experience with insurance review to gather additional information, as necessary.Identifies and researches unusual, complex or escalated issues as assigned; applies problem-solving and critical thinking skills as necessary to resolve issues within the scope of position authority.

  • Collaborates with Patient Advocacy, Quality, and Risk departments as needed to resolve quality/risk adjustment requests from clinics.

  • Identifies trends in clinic questions and billing issues, and proactively resolves in accordance with established guidelines.

  • Notifies Supervisor/Manager of other ongoing issues and concerns.Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation and written responses to clinic issues; maintains confidentiality of medical records.

  • Meets quality assurance and productivity standards for timely and accurate account resolution in accordance with organizational policies and procedures. Maintains current knowledge of internal, payer, and government regulations as applicable to assigned function.

  • Explains challenging payer requirements and regulations to clinics to prevent billing issues.

  • Has knowledge of, and is compliant with, government regulations including "signature on file" requirements, compliance program, HIPAA, etc.Establishes and maintains professional and effective relationships with peers and other stakeholders.

  • Works collaboratively with payers and revenue cycle staff to explain denial or underpayment issues.

  • Establishes and maintains a professional relationship with clinics and staff in order to resolve issues.

  • Maintains professional telephone and e-mail communications.

  • Depending on role and practice management training, may be called upon to support other areas in the Revenue Cycle.MARGINAL JOB RESPONSIBILITIES

  • Other duties as assigned by leader and organization.

Qualifications

Required Education and Licensure

  • High School Diploma or GED

Required Minimum Experience

  • Four years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities.

  • Two years customer service experience

Bona Fide Occupational Qualifications (BFOQs)

  • N/A

Preferred Qualifications

  • Graduation from a post-high school program in medical billing or other business-related field is preferred

Minimum Knowledge, Skills, and Abilities

  • Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned function.

  • Knowledge of medical insurance, CPT and ICD codes.

  • Knowledge of clinic operations related to patient registration, referrals and cash collections.

  • Knowledge of general office principles, practices, standards, systems and tools/equipment.

  • Knowledge of medical insurance, payer contract, and basic medical terminology and abbreviations.

  • Knowledge of the regulatory/reporting requirements that pertain to the assigned function.

  • Knowledge of sources and availability of information relevant to the assigned function.

  • Knowledge of the operation and application of automated systems applicable to the assigned function.

  • Ability to enter data in accordance with established standards of timeliness, accuracy and productivity.

  • Ability to understand and apply detailed billing requirements and insurance follow-up practices.

  • Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility.

  • Ability to identify and articulate non-compliance with established guidelines and/or regulatory requirements.

  • Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.

  • Ability to maintain confidentiality of medical records, and to use discretion with confidential data and sensitive information.

  • Ability to demonstrate attention to detail and critical thinking skills within the context of the assigned function, with a commitment to accuracy.

  • Ability to effectively prioritize and execute tasks while under pressure.

  • Ability to make decisions based on available information and within the scope of authority of the position.

  • Ability to demonstrate excellent customer service skills, including professional telephone interactions.

  • Ability to read, understand and communicate in English sufficient to perform the duties of the position.

  • Ability to establish and maintain effective working relationships as required by the duties of the position.

  • Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.

Job Finance

Primary Location NEBRASKA-OMAHA-SERVICE CENTER-SOUTH BLDG

Daily Schedule Days

Scheduled Hours per 2-week Pay Period 80

Weekends Required Occasional

Req ID: 2017-R0130419