RCM Customer Services Associate
US
careers
Req #: 50333
Type: Full Time
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Overview: We have an exciting RCM Custmer Services Associate opportunity. Pediatrix Medical Group is a physician lead organization, and we are one of the nation's largest providers of prenatal, neonatal and pediatric services. Talented business professionals from diverse backgrounds choose Pediatrix because we are an exciting and innovative company that focuses on a team approach to improve the lives of patients everywhere. We offer a diverse range of opportunities, competitive salaries and benefits, and a commitment to clinical excellence, we are confident that you'll love being a part of the Pediatrix team. Responsibilities: The Customer Service Representative is responsible for effectively communicating with Pediatrix clients. Clients include, but are not limited to patients, parents or guardians of the patient, insurance companies, Human Resource Departments, Other Pediatrix employees. Customer Service Representatives will assist clients with balance inquiries, payment information, demographic updates, general billing issues, insurance/ Medicaid updates, and other account related issues. Operate Customer Service line. * Provide clients with correct answer in regards to the account(s) in question. * Verify and update account information. This includes demographic information and correct insurance information. * Obtain payment on accounts that are patient responsibility. Payments include balance paid in full, settlements, and payment plans. All must be within specific regional guidelines. * Transfer accounts to appropriate queues for follow-up. * Document all conversations with clients in Collections Plus Notes in the GPMS system for future reference. * Handle client complaints in a professional and serious manner. * Review accounts for accuracy (correct statement groups, financial class, etc.). * Process adjustments as necessary (settlements, refund requests, etc.). * Perform follow-up on worked accounts when necessary. * Review and work daily correspondence received from patients. * Assist with account audits when necessary. * Elevate problems or trends to the department Manager. * Perform a variety of other duties as directed by incoming calls. Customer Service Liaison * Serve as a liaison between Patient Accounts, payers, and clients when necessary (troubleshoot accounts, fax claims to insurance companies to expedite processing, service/ charge disputes). * Contact payers to check claim status when beneficial to clients. * Perform telephone appeals for denied or low payment claims when requested by client and within company established guidelines. * Process disputes by obtaining medical records and explaining procedures. * Review diagnosis and procedure codes with the Coding Department. * Elevate accounts to Collection Administrators when appropriate. Insurance Verification * Work the insurance verification Tickler Queues when assigned. * Verify new or correct insurance information on patients. * Update account insurance sets. * Send claims to the insurance company. * Contact the patient or patient's family if insurance information does not verify as eligible. * Document the steps involved in the verification and claim submission process in Collections Plus Notes in the GPMS system. Complete special projects and all other duties assigned by the Customer Service Manager. Adheres to all policies and procedures. Qualifications: Education/Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school; or one to two years related experience and/or training; or equivalent combination of education and experience. Software: Experience with GPMS, Master Database, Imaging, Medifax, preferred. Experience with MS Excel, and Word required.
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