Requisition ID: 52500

Location: Presence St Mary Chicago

Location Address:
2233 West Division Street, Chicago, IL 60622 United States (US)

Daily Hours: 8
Standard Hours: 40
Employment Status: Full-time
Employment Type: Regular
Shift: Day
FLSA: N

The Customer Account Specialist III provides billing and follow-up related to patient/customer complaints and advocacy for patients related to complaints or billing issues. Ensures proper submission and adjudication on all claims submitted to third party carriers/intermediaries. This position responds to all inquiries according to Central Business Office (CBO) policy and procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Provides account resolution, within Healthcare Financial Management Association (HFMA) Patient Friendly requirement (i.e., 48 hours), by assessing the service provided, reviewing the billing system for errors and/or various third party payers' contracts for terms that will assist in answering/resolving the patient's issue. Provides the patient with explanation or address any errors found. Documents all activity on patient accounts (i.e., conversations, actions taken, follow-up needed) in the system, according to industry standards.

Identifies any issues, such as a breakdown in the process that causes delay in payment, or repetitive errors that may be encountered during claim submission and processing and provide feedback to management. Collaborates with manager and CBO staff to resolve these issues in order to improve processes, increase accuracy, create efficiencies, and achieve department goals.

Ensures compliance with all state and federal billing regulations by reporting suspected compliance issues to Supervisor/Manager or Compliance Manager.

Completes the follow-up of claims when an error is identified according to the CBO guidelines for account follow-up goals. Submits the necessary re-bill for the claim, monitor and expedite by contacting the assigned payor representatives to ensure the re-bill has been received, re-processed, and payment has been made. Keeps the patient informed of the steps being taken and the status of the claim.

Assists patient in setting up mutually agreeable payment arrangements by explaining the options (i.e., increased future payments, partial lump sum payment with delayed payments for the remaining balance) available to them according to our policy. Refers patient to Financial Assistance/Follow-up Representative to complete the process.

Initiates the Financial Assistance process in the event patients communicate financial difficulty in making agreed-to payments, in accordance with Presence' Health's Financial Assistance Policy. Explains the process to the patient and why the requested information is necessary, mail the application to them and follow-up with the patient to ensure that they fill out the application completely and within the specified timeframe. Responds to patient's questions to assist them through the process. Refers patient to Financial Assistance/Follow-up Rep to complete the process.

Education and/or Experience

High school diploma or GED.

Minimum five years in patient accounting/business office environment, specifically billing and/or collections in the assigned insurance area.

Two years of higher education or Associate's degree in Finance, Accounting or Business preferred.

Ability to apply high level of knowledge of respective insurance billing regulations and guidelines. Above average typing skills preferred.

Business Unit: Corporate (LRHC and LPH)

COMPANY OVERVIEW:

EOE of Minorities/Females/Vets/Disability