Customer Resolution Specialist I

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This is a Stanford Health Care job.

A Brief Overview
Responsible for performing customer care activities in accordance with applicable Federal, State, and local standards, guidelines, and regulations. These responsibilities include, but are not limited to, customer service, billing, and/or patient account balance collection activities associated with the hospital and professional revenue cycle.

Responsible for providing excellent customer service to patients and their families seeking information from the business office and general administrative duties related to patient billing that will facilitate improved revenue. Receives incoming telephone calls and assist patients with information pertaining to their accounts, answers basic billing questions regarding account details and payment options, collects and updates patient information, explains statements and previous insurance payments, and follows established scripts for common inquiries. Knowledgeable in the full scope of medical billing and is empowered to make decisions independently regarding patient financial responsibilities in accordance with departmental policies. Identifies and reports trends and issues impacting the patient financial experience. Exerts a strong ability to deal with difficult customers and can de-escalate callers to productively find a resolution to the caller's concern. Uses sound and thoughtful problem-solving skills to resolve account discrepancies ensuring timely collection of balances. Handles a high volume of inbound contacts, and outbound contacts, as needed. Operates with a high level of professionalism adhering to Stanford's CI-CARE principles in all interactions.

Locations
Stanford Health Care

What you will do

• Provides excellent customer service by resolving concerns and responding to patient inquiries in a professional and engaging manner with a goal of first-call resolution.

• Patient support may include establishing financial arrangements, researching patient disputes, and/or explaining of Revenue Cycle

• Clear documentation of customer encounters entered in Epic Electronic Medical Record (EMR)

• Builds rapport with the caller by remaining calm, empathetic, and displaying patience

• Responds to all communications coming into the department in the form of email, fax, letters, Epic EMR, Epic CRM in-basket.

• Communicates and escalates issues to leadership in writing when necessary.

• Resolves HB and PB customer service inquiries, which could include:

• Insurance verification

• Benefit and eligibility information

• Billing and payment issues

• Authorization for treatment

• Explanation of benefits (EOB)

• Performs or requests adjustments and contractual write-offs as applicable.

• Performs timely and efficient collections of all HB and PB self-pay balances by patients/guarantors and others to collect or arrange budget plan options and resolve issues.

• Performs presumptive charity determinations as applicable.

• Ensures daily productivity and quality standards are met.

• Provides training to other staff members (or temporaries) on particular job functions or demonstrates tasks/duties when required.

• Maintains a thorough, practical understanding of departmental established policies and procedures.

• Maintains a thorough understanding of hospital and professional billing procedures and payment practices of state, federal, and all third-party payers.

• Adheres to Stanford’s CI-CARE principles in all interactions.

• Maintains excellent schedule adherence.

• Performs other duties and responsibilities as assigned.

Education Qualifications

• High School diploma or GED equivalent or equivalent work experience required.

• Associate's Degree in a business-related field preferred

Experience Qualifications

• One (1) year of progressively responsible experience in customer service, payment collection, medical billing terminology, Electronic Medical Record (EMR) systems, or call center roles, preferably in the healthcare industry.

Required Knowledge, Skills and Abilities

• Knowledge of government/non-government payer requirements, reimbursement rules, laws, and regulations that govern billing/collection activities.

• Familiarity with medical terminology, CPT-4, ICD-9, HCPCS, modifier coding, and how these items drive reimbursement.

• Understanding of principles and practices of customer service and telephone courtesy.

• Able to organize, plan, analyze, and problem-solve.

• Attention to detail and follow-through.

• Strong verbal and written communication skills.

• Proficiency in Microsoft Office applications (Word and Excel).

• Experience with Epic Professional Billing preferred.

• Able to communicate clearly in a high paced call center environment and the ability to multitask.

• Ability to document the steps taken while working accounts/handling phone calls in a high-paced call center environment.

• Working knowledge of all systems used in the department.

Licenses and Certifications

• HFMA - Certified Rev Cycle Rep (CRCR) preferred

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.