Customer Service Representative 1 - Patient Account Representative

Department Overview

To bill, process adjustments, collect on accounts, and/or perform customer service duties to ensure that monies due University Hospital are secured and paid in a timely manner and the AR outstanding days of revenue are kept to a minimum. Assignment will be flexible depending on payor mix, patient flow, and workload fluctuations.

Function/Duties of Position

Customer Service

• Receive incoming phone calls relating to issues with patient accounts, completing 66 incoming calls each day.
• Process patient request to combine accounts and set up payment arrangements.
• Review for inappropriate charges.
• Determine which accounts should be escalated to supervisor’s attention.
• Take necessary steps to resolve customer concerns.
• Respond to 10 pieces of written correspondence each day.

Billing

• Submit bills that comply with all appropriate regulations, managed care contracts to third party payors.
• Calculate the correct reimbursement of all managed care claims.

Third party follow-up and collection

• Within the stratified processing environment, collect assertively and proactively money due OHSU by contacting (through telephoning, emailing, and/or accessing on-line systems) third parties (insurance carrier, various government programs, etc.).
• Provide explanation of charges and additional requested information to the third parties.
• Analyze accounts to determine coordination of benefits, refunds, and denials to insure appropriate resolution of accounts.
• Review billing to determine medical records necessary to provide complete processing of claim.
• Analyze accounts with regard to billing and payment history and uses judgment to determines appropriate follow-up action based on departmental guidelines.
• Contact patient/guarantor to resolve issues (includes tracing and locating patient/guarantor by telephoning and/or sending written correspondence).
• Analyze accounts and interpreting contracts that dictate how claims should be paid and processing adjustments for contract interpretation. 
• Comply with special billing and follow-up requirements regarding adoptions, court holds, motor vehicle and personal injury accidents, and other unique or sensitive accounts.
• Work reports of denied claims to trend and report these claims to the department and to our front end partners.
• Work closely with admitting, care management and ambulatory services on the denied claims for resolution and feedback purposes.
• Prepare the appeals for selected denials.

Patient Counseling and Collections

• Analyze delinquent accounts with regard to billing and payment history. Determines appropriate follow-up action based on departmental guidelines; trace and locate debtor by telephoning and/or sending written correspondence.
• Arrange appropriate payment plan within prescribed guidelines; request and review documentation of financial information regarding ability to pay and eligibility for financial allowances.
• File claims to estates of deceased patients.
• Determines which accounts should be referred to external collection agencies; prepare accounts for transmittal to collection agencies and/or other State agencies when internal collection efforts are determined to be inadequate.
• Provide information to outside agencies involved in collection action or legal action against debtor Adjustment and legal document preparation.

Adjustment and legal document preparation

• Analyze accounts and process adjustments for charge errors, contract, and financial allowances.
• Prepare legal documents such as estate filings.

Other duties as assigned.

Required Qualifications

• Two years of recent (within the last 5 years) experience billing or collecting healthcare accounts in a business office; OR

• Four years of general collection, billing or customer service experience; OR

• Equivalent combination of education and experience. 

• Certified Revenue Cycle Specialist (CRCS) is required within 18 months of hire.

Preferred Qualifications

• 2 years of medical collection and/or billing experience within five years of the date of hire.
• 1 year of recent medical collection and/or billing experience within five years of the date of hire.
• Recent (within one year of date of hire) Microsoft Office Suite experience in Windows environment with skill in document production using WORD, spreadsheet construction in EXCEL.
• Experience in billing Hospital claims or UB-04 claims.
• Knowledge of and experience in interpreting managed care contracts.
• Familiarity with DRG, CPT, HCPC and ICD-10 coding.
• Typing 45 wpm.
• Ability to use multiple system applications.
• Demonstrated ability to communicate effectively verbally or in writing.

Additional Details

Monday through Friday. This is a hybrid position – in office and remote.

Deal with hostile, grieving or angry people on a daily basis.

Benefits

• Healthcare for full-time employees covered 100% and 88% for dependents.
• $50K of term life insurance provided at no cost to the employee.
• Two separate above market pension plans to choose from.
• Vacation - up to 200 hours per year dependent on length of service.
• Sick Leave - up to 96 hours per year.
• 9 paid holidays per year.
• Substantial Tri-Met and C-Tran discounts.
• Employee Assistance Program.
• Childcare service discounts.
• Tuition reimbursement.
• Employee discounts to local and national businesses.

Why apply to OHSU?

We are Oregon's only public academic health center. In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. All are welcome. OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact [email protected]