Collections Representative

Kent Campus Hospital

STATUS: Full Time 80 Hours

SHIFT: Days

GENERAL SUMMARY:

Summary:
Entry level medical billing customer service, collection, and payment processing activities. Ability to understand insurance explanation of payment/benefits from all payers. Answers patient telephone billing inquiries for all Bayhealth provider entities. Researches and interprets insurance company explanation of benefits for patients and provides accurate information in explanation of denials. Verifies and adds insurance, undoes and initiates billing as necessary to facilitate claim submission, applies any undistributed amounts to resolve balances. Follows up as necessary to achieve patient satisfaction related to billing services. Monitors current call volumes to determine when to make outbound calls and/or take inbound contributing to an environment with a call low call abandonment rate. Works under limited supervision seeking assistance from supervisor as needed to resolve patient concerns.

ESSENTIAL FUNCTIONS & ACCOUNTABILITIES:

1. Provide timely and professional service to customers via incoming and outgoing calls. Ability to resolve patient questions/concerns during the call with limited assistance from others. Responds to all patients on the call or within 24 hours of speaking with them regarding their concern. Escalates patient complaints as appropriate when timely resolution is not achievable. Contributes to team effort to maintain call abandonment rate below 8%.
2. Listens to patient concern/question and confirms their request before proceeding to resolve their issue. Researches patient concerns thoroughly using all available resources to provide correct information to the patient in response to their inquiry. Ability to properly identify denials and patient responsibility amounts from remittances required. Pre-screen patients for financial assistance programs and refer potentially eligible patients to Financial Counselor. Documents patient’s concern/question, all research performed and information communicated along with resolution.
3. Updates existing patient information. Contacts insurance companies as needed to verify insurance information provided by patients and confirm services provided are covered under benefits. Accurately identifies the correct insurance plan to load on the account and updates insurance information on all affected accounts. Sends electronic communication to departments who may be subsequently required to obtain an authorization. Undoes billing and initiates billing as needed to complete the billing process for new insurance provided by the patient. Transfers balance as appropriate using Epic NRP function to complete the billing process. Applies any undistributed funds identified to respective balance to complete processing of claim in its entirety (mostly for Medicare crossover claims when secondary insurance is missing). Processes address change report from statement vendor daily.
4. Complete daily workflow requirements in various system work queues for all self-pay AR and return mail; maintains all queues within departmental targets for volume and/or age. Uses appropriate Actions, Standard Notes, etc., to enable accounts to continue through the life cycle timely and facilitate reporting needs. Complete Bad Debt patient phone calls from work queues within departmental time frames. Complete electronic logs to provide related quality improvement records.
5. Collect patient liabilities and establish payment plans according to policy and productivity requirements. Processes credit card payments received over the phone correctly. Audit and reconciliation of individual cash drawer, post payments and adjustments to patient accounts, accepts and processes credit card payments, cash and checks for both Epic and legacy accounts receivable.
6. Posts corrections contractual adjustments in Hospital Information System when errors have been identified. Reviews balance due changes with patient. Processes bankruptcy notices as received; communicates all bankruptcies to bad debt agencies timely to ensure proper cessation of collection activities.
7. Processes collection agency return files in an accurate and timely manner. Works delinquent agency return work queue to ensure the EMR reflects accurate agency placement and accounts are returned per contracted terms. Notifies management when agencies are not complying with contract terms and/or sending return files.
8. Responds to information requests from agencies and attorneys.
9. Escalates patient complaints and other issues to management as appropriate for resolution
10. Adheres to assigned schedule of availability to handle phone calls for hours the department is open
11. Achieves departmental productivity, collection, call abandonment and quality assurance goals.

REQUIRED MINIMUM EDUCATION AND CREDENTIAL:

• 
  
  
  
• Credential

EXPERIENCE:

Required: No experience required.

Preferred: One year medical billing and collections (including dental & vision) for payers.

PREFERRED EDUCATION AND CREDENTIAL:

• Education
• Credential

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