Patient Solutions Specialist

Description
Job Title:  Specialist, Patient Solutions

Company:  Acclara

Department:  Patient Solutions

Leader:   Supervisor, Patient Solutions

FLSA Status:  Hourly/Non-Exempt

Work Location: Remote within the United States

Travel:  No travel required

Compensation:  $14.00 – 20.07

OVERVIEW

The Patient Solutions Specialist 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.
Analyze 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
May compose correspondence to payers, third parties, and patients regarding the resolutions of outstanding balances and claim appeals
Handle inquiries via multiple communication channels and 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
Attempt to assist and resolve patient inquiries and concerns before seeing assistance from others
Research payer rules and regulations to maintain current knowledge
Adhere to HIPAA and other compliance requirements at all times
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.
Ability and willingness to float to other departments and support multiple clients as needed
Provide backup and assistance as needed to Lead, Patient Experience
Assists with new hire and team member training/mentoring
May assist with supervisor level calls
Assist with special projects
Other duties as assigned
QUALIFICATIONS

High school diploma or GED
3+ years of previous work experience as a patient services/customer service representative
Advanced knowledge 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
Advanced knowledge of health care industry terms
Excellent problem-solving and critical thinking skills to research information using available resources.
Consistently meets or exceeds department performance metrics such as productivity and quality standards
Ability to be flexible in a fast-paced environment and adapt with change
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
Strong math skills to be able to calculate discounts, payment plan arrangements, validate contractual and out of picket patient liability

Preferred Qualifications

Bilingual English/Spanish