Job Abstract

UPMC Hamot Physician Network Outpatient Coordination Center is seeking a dedicated individual to join our team as a Contact Center Specialist! In this role, you'll be at the forefront of our Contact Center Revenue Cycle activities, serving as the primary point of contact for patients. As an advocate for our patients, you'll provide guidance, education, and support on various aspects of their healthcare journey, including scheduling and special projects that support the physician network. A perk of this role is a convenient location as well as parking!

If you're passionate about providing exceptional patient care and ensuring their satisfaction throughout their healthcare journey, apply now to join our team as a Contact Center Specialist with Physician Network Admin.

The Contact Center Specialist will provide support for the Contact Center Revenue Cycle activities by serving as the first line of contact for the patient. The Contact Center Specialist acts as an advocate for patients by providing guidance, interpretation and education on scheduling, registration, billing, claim status, and various customer related inquires. Responsible for efficient and courteous resolution to verbal and written inquiries to ensure customer satisfaction while maintaining call servicing and quality standards. Typically, functions under the direction of the Supervisor/Manager.

Responsibilities:

• Review, verify and enter the patient's demographic and insurance information to ensure data integrity. Answer multi-line telephone system and schedule appointments, contact or page physicians according to department questionnaires, protocols and templates. Understand UPMC 72-hour appointment requirement and work to ensure guidelines are met while still placing the patient with the right sub-specialist whenever possible to avoid return visit to see the correct sub-specialist.
• Complete follow-up on unpaid account balances. Contact guarantors, third party payors, and/or other outside agencies for payment of balances due.
• Identify and take action towards resolution of problematic accounts through potential refunds, adjustments, payment transfers, etc. to bring balance to zero. Adhere to Fair Debt Collection Practices Guidelines and understands the laws and regulations applicable to job functions.
• Contact patients to discuss their post-discharge appointment requirements; follow up and coordinate all appointments for the patient.
• Demonstrate the ability to understand the reason for a consumer referral call. Use decision making ability to appropriately refer a physician, class or program to meet the consumer's needs.
• Establish reasonable payment plans according to department policies; set up payment arrangement in system and monitors payments for consistency and timeliness. Counsel patients on various local, state and federal agencies, which may be available to assist with funding of health care.
• Identify, review, and research credit balance accounts, potential refunds, adjustments, payment transfers, etc., to bring the account balance to zero.
• Document all actions taken on a patient account. Review on-line account history and EOB's to ensure all payers have been billed and to validate the accuracy of payments and adjustments posted.
• Research, resolve and respond to email, web and telephone billing inquiries from patients and insurance carriers in accordance with departmental protocols.
• Demonstrate the ability to understand the reason/needs for the patient or clinicians call and apply the decision making ability to page or contact the appropriate physician to meet the patient's needs.
• Review and take action on accounts on aged trial balance reports or in assigned work queue meeting specified dollar and age criteria to ensure lowest number of days possible on accounts receivable. Assign accounts deemed un-collectible to external collection agencies on a monthly basis.

High school graduate or equivalent.

2 years customer service experience or call center experience required

OR 1 year health insurance call center and claims adjustments experience required.

Detail Oriented. Advanced knowledge of health insurance, third party payor billing requirements, medical terminology and reimbursement practices preferred. Must be able to maintain confidential information. Excellent organizational, interpersonal and communication skills. Competent in MS Office/PC skills. Must be able to make appropriate decisions based on the circumstances as well as established protocols. Must have strong interpersonal, organizational, and communication skills and be able to remain professional and courteous when dealing with sensitive issues and stressful circumstances.

Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran