The Customer Service Representative is responsible for responding and providing information to patients and employees regarding billing questions and concerns. The CSR informs patients regarding billing and insurance processes. Performs insurance and patient pay billing and collections, maintaining acceptable accounts receivable balance(s). The CSR verifies payer explanation of benefits and remittance advice for claims and assigns applicable appeals, following payer guidelines.
Serves as a resource for billing/insurance processes for patients and employees.
Explains patient/payer responsibilities and obligations.
Responds to staff inquiries for account restrictions.
Performs, understands and can explain functions related to account balancing.
Performs basic accounting procedures.
Explains to patient and payer details of account balancing.
Processes account maintenance adjustments and transfers.
Processes insurance claims and patient statements.
Verifies patient demographic and insurance information.
Verifies insurance eligibility via on-line access or by phone.
Reviews payer explanation of benefits and remittance advice for patient claim payments.
Collects patient-responsible co-pays, co-insurance, and deductible charges from the patient and/or responsible party.
Processes electronic payments.
Processes collection agency payments.
Determines and initiates insurance/patient refund processes.
Verifies accuracy of refund request against credit balance.
Submits refund request to accounts payable and/or insurance carrier.
Searches and resolves unidentified payments to applicable accounts.
Communicates directly with patients and payers as needed.
Investigates payer rejections/denials and generates appeals according to payer guidelines.
Verifies accuracy of claim information by performing on-line verification.
Reviews medical record for claim information.
Contacts payer for rejection clarification.
Provides payer with additional information as requested for claim resolution.
Contacts patients or responsible individuals to discuss delinquent accounts.
Investigates and corrects errors in billing accounts to ensure records are accurate.
Contacts attorneys, insurance companies, employers, etc., to obtain and provide information necessary in handling credit and collection matters.
Evaluates patients financial status and establishes payment plan; reviews accounts for possible referral to collection agency.
Assigns approved accounts to an outside collection agency.
Responds promptly and accurately to patient inquiries or complaints.
Processes bankruptcy notification(s) to guarantor accounts.
Identifies applicable accounts against bankruptcy notice.
Documents bankruptcy information into practice management system.
Files proof of claim with bankruptcy court.
One year of recent insurance and patient-pay billing experience
Knowledge of third party payers, billing procedures and insurance.
2 + years recent insurance and patient-pay billing experience.
Previous experience with insurance claims and private pay processing in a medical office setting.
Additional Requirements (must be obtained or completed within a period of time) :
Excellent customer service and communication skills.
Ability to work independently and exercise independent judgment.
Ability to prioritize and deal with fluctuation in workload.
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership ...with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.