Representative, Patient Solutions [United States]

 

Job Title: Representative, Patient Solutions

Company: Acclara

Department: Patient Solutions

Leader: Supervisor, Patient Solutions

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FLSA Status: Hourly/Non-Exempt

Work Location: This position is remote within the U.S.

Travel: No travel required

Compensation: $14.25 - $20.07

OVERVIEW

The Patient Solutions Representative is responsible for delivering a high-quality patient experience through inbound and outbound calls assisting patients, their representatives and/or payers with inquiries and concerns in a confidential and professional manner with a focus on first-call resolution when possible. Identify type of assistance needed such as updating information, making a payment, payment plan arrangements and insurance related questions to ensure proper account resolution.

Responsibilities include:

• Deliver a high-quality patient experience thought inbound and outbound customer service calls. Determine assistance needed (i.e., benefit and eligibility, billing and payments, authorization or treatment, EOBs, etc.) and take appropriate action on the related accounts in a timely manner while upholding a high level of professionalism and accuracy.
• Review patient statements/EOBs, balances, identify unapplied adjustments
• Ask appropriate questions and listen actively to identify specific concerns or issues while documenting all required information in computer systems in a clear and concise manner
• Provide one call resolution to patient inquires whenever possible and perform timely follow up
• Review incoming correspondence, taking appropriate and timely action by updating the respective accounts
• May review the Payment Plan, No Statement, Special Handling, Expired, and Bankruptcy tickler queues designated for follow up, taking appropriate action
• Provide patient education regarding how to understand their Explanation of Benefits (EOB)
• Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
• Comply with HIPAA and other compliance requirements at all times to protect patient confidentiality
• May be required to identify contractual and administrative adjustments
• Effectively navigate several computer applications during and after phone calls, document all actions taken in appropriate company and/or client systems
• Adhere to benchmarks and strive for continuous improvement on customer service metrics such as: adherence to schedule, call abandonment rate, speed to answer, talk time, wrap (documentation) time, etc.

QUALIFICATIONS

• High school diploma or GED
• 1-year previous work experience as a patient services/customer service representative
• Understanding of patient/customer service and insurance follow-up concepts (i.e., billing, collections, managed care, Medicare, Medicaid and Commercial Practices), and well-developed interpersonal skills
• Basic knowledge of health care industry terms
• Strong problem-solving and critical thinking skills to research information using available resources.
• Ability to be flexible in a fast-paced environment and adapt with change
• Ability to perform at a high level of productivity and quality
• Detail oriented with the capacity to maintain a high level of accuracy
• Excellent written and verbal communication skills
• Ability to navigate through multiple software and computer applications
• Ability to perform under pressure while maintaining a calm and professional manner
• Basic math skills to be able to calculate discounts, payment plan arrangements, validate contractual and out of picket patient liability

Preferred Qualifications:

• 1-year experience in a call center environment (healthcare experience a plus)
• Bilingual English/Spanish

Physical Requirements:

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Listed below are the physical requirements required while performing the duties of this job.

• The employee is regularly required to: stand; sit; talk; hear; use hands and fingers to operate a computer and telephone keyboard; and reach, stoop and/or kneel to install computer equipment
• The employee must have the specific vision ability to complete close vision requirements due to computer work
• The employee is required to be able to complete light to moderate lifting

Our Commitment to Diversity, Equity, and Inclusion

We welcome and respect the variety of experiences, viewpoints, and cultural backgrounds that everyone brings to our workplace. Acclara makes every effort to promote a workplace where leaders model inclusive behaviors and individuals feel respected, valued, and empowered. Together, we promote and sustain an inclusive workplace where people feel a sense of belonging

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