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The SBO/Customer Service unit is responsible for responding to all incoming inquiries from patients, departments, various billing agencies and other external inquiries. The SBO/Customer Service Rep has frequent contact with patient, Patient Financial Services staff, clinic and hospital staff and management, and managers, as well as billing and professional fee and collection services vendors.
The SBO/Customer Service Representative has a working knowledge of UCSF Medical Center and Medical Group insurance contracts as the unit deals regularly with complex policy and procedural issues that involve contract compliance with regard to HMO, PPO and government payers. The SBO/Customer Service Representative negotiates prompt payment discounts and sets up payment plans according to departmental guidelines. The SBO/Customer Service Representative has a working knowledge of the UCSF Medical Center discount and charity policy. The SBO/Customer Service Representative recommends accounts for collection agencies.
The SBO/Customer Service Representative is responsible for responding to and following up on issues regarding patient’s outstanding account receivable in a courteous and timely manner with constant communication with patients and/or guarantors, other MGBS units, UCSF clinical departments, payers and various billing agents. The SBO/Customer Service rep demonstrates the ability to process all customer service inquiries and to perform all aspects of follow-up with quality. The SBO/Customer Service rep will conform to all UCSF, MGBS, government and HIPAA policies and procedures.
SBO/Customer Service Representatives utilize multiple databases and applications to analyze and take appropriate action on information or documents received. Applications and Databases consist of: Epic, Patient Compass, Emdeon eCashiering, MS Outlook, MS Excel, Hospital Rates, Cirius, Imaging, MyQuote, Medi-Cal, Medicare, and other payer websites, SMS/LDA, IDX/LDA.
DUTIES & ESSENTIAL JOB FUNCTIONS
Answer incoming telephone calls via the ACD telephone system within the timely standards defined by the unit following HIPAA mandated rules.
Respond and resolve inquiries, which may include, but are not limited to, explain patient and insurance billing policies and procedures, pricing, patient appeals, missing payment and quality of care issues for both hospital and professional services.
Examines and evaluate accounts for appropriate follow-up action.
Interpret and enter detailed on-line notes in order to understand past activity and to provide an audit trail for future follow-up, using appropriate SBO Note Type.
Determine correct payer, when appropriate; such as Government, Non-Government, HMO, PPO, Worker’s Compensation, Research/Study and other payers.
Determine eligibility for financial assistance following established policy.
Secure guarantor/patient demographic and/or insurance information and update/correct the on-line system as needed.
Secure patient payments by collecting credit card information and process using Patient Compass.
Calculate and post self-pay discounts, charity and contractual.
Arrange payment plans towards total guarantor liability in accordance with guidelines.
Prepare accounts for transfer to collection agencies.
Maintain WQs as assigned.
Initiate Charge Corrections request.
Research missing payments by reviewing Epic, EOB (Explanation of Benefits), IDX/LDA, SMS/LDA and Imaging. Review and process payment transfers.
Retrieve all required information needed in order to evaluate credit balances and/or correct refund payee.
Complete and submit refund requests with detailed back up to management for approval.
Submit requests to departments/clinic via RFI process for review response and appropriate action.
Retrieve voice mail messages and returns all phone calls within the timely standards defined by the unit.
Retrieve electronic mail messages and respond within the timely standards defined by the unit.
Effectively communicate with patients, payers, UCSF departments and outside billing agents.
Utilize knowledge of various systems including, but not limited to:
Epic, Patient Compass, Emdeon eCashiering, MS Outlook, MS Excel, Hospital Rates, Cirius, Imaging, MyQuote, SMS/LDA, IDX/LDA, Medi-Cal, Medicare, and other payer websites, and any other information systems which would be required for insurance eligibility, benefit verification or other information needed for follow-up.
Provide back-up for the Correspondence Unit, as needed, in accordance with departmental procedures.
Notify manager of issues that affect performance improvement.
Mentor and assist in training new employees.
Attend department, unit, and other meetings as required.
Perform other duties as assigned.
1. Minimum of 2 years of experience in a hospital billing, physician billing, or payor office environment.
2. High school graduate or GED certificate.
3. Must demonstrate an in-depth understanding of all aspects of billing procedures greater than a Billing Assistant III.
4. Working knowledge of contracts, insurance billing requirements, UB04 and HCFA 1500 claim forms, Workers’ Compensation, HMOs, PPOs, capitation, Medicare, Medi-Cal and compliance program regulations.
5. Excellent interpersonal, verbal, and written communication skills.
6. Ability to demonstrate cultural sensitivity and a respectful, courteous and professional manner in all interactions.
7. Ability to balance assertiveness with compassion for the patient and others.
8. Good analytical and organizational skills.
9. Proactive and assertive account resolution skills.
10. Must be a motivated individual with a positive and exceptional work ethics.
11. Ability to follow directions and written procedures.
12. Working understanding of CPT, ICD, DRG, and HCPC codes.
13. Thorough knowledge of computer operation, keyboard functions, calculator, copier and fax machine operation with standard keyboard skills.
14. Computer software skills (i.e. Microsoft Applications and E-mail, etc.)
15. Thorough understanding of HIPAA rules and regulations.
1. Medical terminology experience.
2. Working knowledge of electronic billing systems (i.e. NEIC, Cirius, Client, Envoy, etc.).
3. Working understanding of stop losses, per diems, carve outs and other contract terms and conditions
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