Job Title: Billing Customer Service Representative (CSR)

Company: TPIRC

Location: Long Beach, CA

Hours: Full Time Exempt; M-F 8AM-5PM

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Who We Are:

The Translational Pulmonary & Immunology Research Center (TPIRC) is a cutting-edge research and clinical care center that is revolutionizing treatment for rare and orphan diseases. Through the use of comprehensive diagnostic tools and patient-driven research, we seek to improve the quality of life for children and young adults each and every day.

Why TPIRC?

TPIRC is home to many innovative thinkers, problem solvers, and passionate leaders. The work we do is truly life-changing for our patients and their families; each member of our team will experience how their role supports our mission! TPIRC provides a challenging and rewarding environment where employees’ talents are leveraged, ideas are encouraged and growth is always inspired.

Who Are We Looking For?

We are seeking a Billing Customer Service Representative (CSR). The Billing Customer Service Representative (CSR) is responsible for the daily activities associated with patient billing inquiries and related patient concerns at TPIRC. This role works directly with patients, insurance companies, financial counselors, scheduling, business office, vendors, and clinical departments to ensure all records are up-to-date, compliant with billing and coding guidelines, and consistent. This individual is responsible for providing resolution to patient inquiries and/or grievances related to all aspects of the medical billing process. The Billing Customer Service Representative will demonstrate knowledge in all areas of the medical billing process and will serve as the Patient Resolution expert for the organization.

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Benefits:

• Health Insurance
• Vision Insurance
• Dental Insurance
• PTO Days
• Paid Holidays
• 401K Plan (matched)
• Professional Development
• Paid Training
• Company Sponsored Events
• Competitive Rates
• Paid Family Leave
• Growth Opportunities

Essential Functions:

Billing Customer Service:

• The Billing CSR will assist with inquiries related to invoices, statements, claims, insurance eligibility, benefits, authorizations, coding, collections, balance variances and payments providing patient resolution to inquiries.
• The Billing CSR will participate in relationship management activities with guarantors, vendors, payors and internal departments.
• The Billing CSR will handle a high volume of incoming customer service calls and tickets.
• The Billing CSR will handle verbal and written inquires, respond to and follow-up accordingly, to the point of final resolution.
• The Billing CSR must be able to communicate clearly to identify issues and concerns - using active listening to understand the root cause.
• Investigates, through coordination with the Call Center and other areas involved in the scheduling of services, providing the services, coding, processing the claim and final billing.
• Makes recommendations for any adjustments to outstanding bills and upon approval processes related adjustments timely.
• Communicates findings to internal areas and/or to the guarantor directly - communication is on incoming/outgoing phone lines, email, fax, mail, and tickets.
• Promptly act on escalated issues: identify, investigate, and coordinate any billing corrections.
• Reconcile patient accounts ensuring accuracy and ease of understanding for guarantor or authorized patient advocate.
• Communicates with and educates the responsible party on the nature of billing and options for payment, including types of payment, payment plan, financial assistance and prompt pay options.
• Able to manage and de-escalate
• Ensures customer satisfaction and promote a positive corporate public image.
• Maintain ethical and professional standards.
• Maintain individual productivity and performance standards.
• Performs job duties with oversight.
• Other duties as assigned.

Medical Billing:

• Responsible for coordinating the timely submission of professional medical claims to various payors.
• Responsible for coordinating the timely submission of secondary claims via electronic and/or paper claim submission.
• Responsible for coordinating and/or submitting claims with required documents, per payor guidelines or as requested (i.e., medical records).
• Review patient statements for accuracy and completeness.
• Maintain a current understanding of local coverage determinations, payor and coding guidelines to ensure claims are consistently billed properly.
• Keep abreast with medical coding updates.
• Maintain confidentiality and is knowledgeable of AMA CPT, HCPCS, and ICD codes and HIPPA guidelines.
• Ensure patient and insurance demographics is accurate.
• Ensure appropriate authorization or referral numbers are on the claim.

Eligibility and Benefits Verification:

• Perform eligibility and benefits inquiries for both new and established patients, as needed.
• Enter and make the appropriate changes in the EMR/PM system(s) and Salesforce regarding guarantor, payor, insurance eligibility and benefits coverage.
• Determine and update copayment, coinsurance, deductible, and out-of-pocket amounts.
• Verify eligibility and benefits using a real-time system response, through health plan portals, and/or via telephone to the health plan and/or guarantor.
• Responsible for verifying COB information and communicating with the health plan and/or guarantor, and/or internal departments.
• Authorizations:
• Coordinate supporting documentation as needed to health plans or referring providers.
• Proficient with turnaround time compliance in all aspects of the prior authorization process.
• Enter and make the appropriate changes in the EMR/PM system(s) and Salesforce regarding referral/authorization status.
• Coordinate request for continuity of care
• Document instructions for the clinical team in the EMR/PM system(s) and Salesforce.
• Coordinate resolution of referral and authorization tickets via Salesforce.
• Coordinate resolution of emails and phone calls related to referral and authorizations.

Collections:

• Maximize revenue by coordinating appropriate follow-up and document actions taken.
• Ability to read and interpret an explanation of benefits.
• Knowledge of a CMS-1500 claim form and field requirements.
• Monitor and maintain revenue integrity through appropriate account adjustments, small balance write-off and payment reconciliations.
• Reconcile customer disputes as they pertain to payment of outstanding balances.
• Respond to correspondence timely.
• Coordinate resolution of credit balances and refunds.
• Document instructions for the RCM team in the EMR/PM system(s) and Salesforce.
• Coordinate resolution of patient statement and claim tickets via Salesforce.
• Coordinate resolution of emails and phone calls related to patient statements and claims.

Payment Posting:

• Ensure proper adjustment transaction codes to write-offs and denials are posted.
• Coordinate research and request missing explanation of benefits or remittance advice.
• Work directly with the Finance and Billing/Collections teams to ensure accurate and timely posting, both electronically and manually, with daily reconciliation.
• Verifies and researches payment information and enters adjustments as necessary to ensure proper filing of supplemental claims to insurance companies and accurate patient statements.
• Coordinate approved refunds.
• Monitor and maintain revenue integrity through appropriate account adjustments, small balance write-off and payment reconciliations.
• Consistent application of financial policies and payment processing procedures and adherence to internal controls in conformity with generally accepted accounting principles is required.
• Follow all end of month and year-end expectations and guidelines.
• Maintain required payment records, reports, and files.

General:

• Collaborate with patients or customers, third party institutions and other team members to research and resolve billing inconsistencies and errors.
• Collect and maintain patient demographic and medical information required for medical billing.
• Ensure patient documentation is scanned and filed correctly within the Electronic Medical Record (EMR.)
• Provide exceptional customer service.
• Maintain and understand various medical billing software platforms.
• Navigate insurance websites and answers customer inquiries.
• Understand office visit fees including procedure and diagnosis codes.
• Maintain confidentiality and adhere to HIPAA regulations.
• Complete assigned tickets as required.
• Adhere to policies and procedures, update of forms and manuals.
• Assist in development and communication of SOP for key areas to improve accuracy and understanding of processes.
• Support daily, weekly, and monthly medical billing metrics.
• Identify issues and present possible solutions and/or suggestions to management.
• Interfaces with other departments to resolve medical billing workflows.
• Assist other staff and support the team approach.
• Communicate appropriately and clearly to management, co-workers, and physicians.
• Maintain all reference material that is provided by the supervisor, manager, or director.
• Know and follow the Employee Handbook policies and procedures.
• Maintain patient confidentiality so that HIPAA compliance is always observed.
• Demonstrate honesty and integrity in everyday activities.
  

Qualifications:

• High School diploma or equivalent required.
• Customer Service experience required.
• Medical billing and coding certification preferred.
• 3+ years of experience in medical billing strongly preferred.
• 3+ years of experience in a specialty group practice preferred.
• Comfortable navigating across various computer systems to locate critical information.
• Knowledge of insurance policies/guidelines, EOB (Explanation of Benefits), prior authorization/referral processes, medical terminology, CPT/ICD/HCPCS coding preferred.
• Experience with a CMS-1500 claim form.
• Experience working with clearinghouses for the purpose of claim submissions.
• Experience with payor portals and affiliates.
• Experience with EMR and PM systems (Athena, AdvancedMD a plus)
• Experience using Salesforce a plus
• Must have strong analytical skills, proficient with spreadsheets
• Knowledge of health networks, IPA, HMO, PPO and contract affiliations.
• Exceptional organizational, presentation, and communication skills, both verbal and written.
• Proficiency in meeting deadlines and prioritize workload.
• Ability to work independently, with direction, and as part of a team.
• Experience with Microsoft Office Suite
• Self-motivated, team-oriented, very responsible, and focused on exceeding customer expectations.

Working Conditions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is required to walk between multiple office locations that include the use of stairs (elevator is only available in some instances).

This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.

Physical Requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee will be required to sit for long periods of time. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is required to walk between multiple office locations that include the use of stairs (elevator is only available in some instances).

This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.

TPIRC provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, veteran status, or any other consideration made unlawful by federal, state, or local laws. TPIRC is committed to providing reasonable accommodation for qualified applicants, and employees with disabilities to ensure they enjoy equal access to all employment opportunities and benefits of employment as required by the Americans with Disabilities Act.