Customer Service Representative - PFS / Revenue Cycle - Sharp Corporate - Day Shift - Full Time

Facility: Corporate OfficesCity San DiegoDepartmentJob StatusRegularShiftDayFTE1Shift Start TimeShift End TimeCertified Revenue Cycle Representative (CRCR) - HFMA; Certified Specialist Managed Care (CSMC) - Healthcare Financial Management Association; H.S. Diploma or EquivalentHours :Shift Start Time:8 AMShift End Time:4:30 PMAWS Hours Requirement:8/40 - 8 Hour ShiftAdditional Shift Information:Weekend Requirements:No WeekendsOn-Call Required:NoHourly Pay Range (Minimum - Midpoint - Maximum):$24.693 - $30.866 - $37.040The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.What You Will DoReceive, resolve, and respond to incoming and generate outbound calls, live chat and walk-in patients for inclusion in the following areas the PFS divisions of Community Care (CCD), Institutional Care (ICD), Managed Care (MC), and SharpCare (SC) in a manner reflecting the Mission, Values, and Philosophy of Sharp HealthCare. Responsible for responding to all patent and provider billing questions, concerns, and inquiries promptly, courteously, and professionally.Required Qualifications

2 Years Experience in customer service, medical billing, patient services, member services, patient accounting or claims processing.

Preferred Qualifications

H.S. Diploma or Equivalent

1 Year Experience with Automated Call Distribution (ACD) system in a call center environment.

Certified Revenue Cycle Representative (CRCR) - HFMA -PREFERRED

Certified Specialist Managed Care (CSMC) - Healthcare Financial Management Association -PREFERRED

Other Qualification Requirements

CRCR certification is required within 1 year of hire. Department management is required to track the completion and maintenance of this certification.

Essential Functions

Service LevelAchieve an overall departmental service level of 80% or greater. This is achieved by answering within 60 seconds or less.

Patient Satisfaction SurveyA monthly outbound survey of patient feedback. Goal is to achieve an average score of 80% or higher.

Cash GoalsCash- Average of ICD and CCD cash collections scoresCCD- Total of Customer Service, Self-Pay, and online collectionsICD- Straight self-pay and self-pay after insurance.

Individual Performance StandardsPerformance errors including but not limited to HIPAA breaches, balance/transaction adjustments, insurance, credit cards, CRRs, ARRs or failure to follow vendor guidelines (PMS, Peatman, Clear Balance, MedFi)

Average Handle TimeHandle patient inquiry in a manner consistent with department guideline at 8:31 minutes or less

Phone ProductionThe amount of work accomplished during assigned work hours, is measured by the percentage of time available to take calls when signed in to an ACD system. Demonstrates consistent call volume according to department guidelines and minimizes unproductive time and unapproved break codes.

Adherence to daily scheduleAdherence measures the agent's accuracy in following their individual daily time schedule provided by the Workforce Management Team. Consistent adherence demonstrates consideration to department needs.

YATE Customer serviceReceive and resolve incoming calls for the Customer Service Department with a focus on patient experience reflecting the Mission, Values and Philosophy of Sharp HealthCare.Demonstrates exemplary customer service, conducts calls using YATE approved guidelines and scripting to ensure patient satisfaction as listed below.Account Actions- Accurate account documentation and demonstrated proficiency in system knowledge by utilizing Sharp HealthCare applications, tools and resources.Call Handling- Consistently follows all HIPAA requirements, properly reviewing account to provide accurate information, andPhone Etiquette- Incorporating soft skills while educating patients with a focus on providing a courteous and personalized experience.Negotiations- Accurately follows department guidelines, policies and procedures regarding payment plans and patient discounts with a focus on reducing A/R days.Wow Factor- Applying critical thinking skills to resolve complex billing issues. Deescalate dissatisfied callers by demonstrating empathy with a focus on service recovery.

CollectionsApplying critical thinking to resolve balance within A/R by collecting balance in full, negotiating settlements, Recurring payment plans, bank loans or financial assistance.Insurance= Verifying eligibility and benefits via One Source for commercial and government plans. Add insurance to patient account by adding the appropriate financial class code and follow appropriate process to assure claims are submitted in an accurate and timely fashion according to payor guidelines. Review explanation of benefits to ensure accurate billing and patient responsibility.

CommunicatonIntradepartmental and Interdepartmental communication within the Sharp HealthCare Organization to ensure patient’s billing questions, concerns and inquiries are resolved promptly. Communication includes but is not limited to Sharp Health Plan, SRS clinics, SRS Managed Care, SCMG, SharpCare, Onsite hospital PAS staff, Onsite Business service representatives, Patient Relations, Patient Contact Center, Technical Assistance Center, etc. External communication including but not limited to, Health Plans, Provider Offices and Sharp HealthCare Vendors.

Call CenterReceive and resolve a high call volume of inbound and outbound calls via the ACD system. Expected call handling is 56 calls per day, with the expectation of handling each call within the identified AHT guidelines.

(CS) Specialty QueuesOut unit handles incoming calls for SRS managed Care and Sharp Care. Responsibilities include answering questions from providers, health insurances and members, regarding referrals and claims for services provided to SRS HMO members at outside organizations. Representatives also provide education regarding SRS managed care processes, and services available at SRS for HMO members. Representatives also communicate any identified errors to appropriate unit (claims, claims support, eligibility, utilization management for resolution)

Professional CompetencyObtaining the Certified Revenue Cycle Representative (CRCR) is due within 12 months from date of hire. Department management is required to track the completion and maintenance of this certification.

Knowledge, Skills, and Abilities

English as primary language.

Additional communication skills in Spanish, Tagalog, or Farsi a plus.

Working knowledge of technical or professional medical billing practices including understanding of contract language.

Working knowledge of medical terminology, ICD procedure and diagnosis codes, CPT codes, HCPCS codes.

Working knowledge of PC functionality.

Ability to type 45WPM and basic math skills.

Strong professional level of written and oral communication skills.

Clear understanding of Fair Debt and Collection Practices Act (FDCPA)-preferred.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class