PFS Escalation Specialist

Hourly Pay Range:

Position Highlights:

• Position: PFS Escalation Specialist
• Location: Arlington Heights, IL
• Full Time/Part Time: Full Time
• Hours: Monday-Friday, 40 hours, onsite

A Brief Overview:
Reporting to the PFS Escalation Manager, is responsible for all interactions with patients/guarantors and third-party vendors pertaining to SBO (single billing office) functions including reconciling account balances, handling customer service issues, and resolving billing related escalations. Responsible for maximizing payment recoveries, ensuring account maintenance is completed in a timely manner while promoting vendor adherence to the Company guidelines.

What you will do:

• Provides customer and vendor support and assistance by researching, resolving, or referring customer inquiries, i.e. patients, physicians, attorneys, regarding billing and collection practices.
• Assumes a patient advocacy role by following through on all aspects of patient accounts.
• Deciphers Commercial, Government and Managed Care contracts in order to effectively communicate with patients and third party intermediaries regarding account status; expedites payment and/or brings resolution to accounts including processing of refunds and other account adjustments.
• Makes corrections as applicable or forwards to appropriate Claims Processing Specialists for resolution.
• Prepares call records for each call that requires follow up.
• Documents a brief summary of the call on patient's computer record.
• Serve as a point of contact for vendors and collection agencies.
• Communicates with vendors via phone, secure email, and applicable technologies and ensures vendor adherence to the Company's guidelines.
• Reconciles and transfers relevant files and accounts to vendors/external agencies in a timely manner and updates account status when agencies find insurance or address data updates.
• Performs proactive vendor account management to reduce adjustments and increase financial performance.
• Tracks and trends common vendor collection issues and informs manager for education and correction of these issues.
• Maintains database of statistics relative to work performed, i.e. telephone statistics, production statistics, etc.; tallies statistics on an ongoing basis. Performs analysis off of system generated Patient Accounting reports that show why patients have called.
• Presents statistics to management for review.
• Participates in development of customer-orientated bills and professional communications; serves as a key resource by providing customer feedback regarding hospital and physician billing/communication processes and makes recommendations for process improvement initiatives.
• Performs analysis of noted trends.
• Assists in developing plans, programs and practices to improve the efficiency, accuracy and quality of the work unit and presents recommendations to manager.
• Meets productivity and quality targets, error ratios, and reporting requirements, as assigned by the department manager or supervisor, ensuring payments are made properly and in full per contractual agreements.
• Provides individual contribution to the overall team effort of achieving the department accounts receivables goal.
• Assists in identifying opportunities for system and process improvement and submits to manager.
• Utilizes assigned menus and pathways in the hospital mainframe system and foreign software applications.
• Report software problems when appropriate.
• Supports team and fills in for staff as assigned.
• Drafts and submit letters and reports in accordance with departmental policy and procedure.

What you will need:

• Education: Associates Degree Required or Bachelors Degree Preferred
• Experience: 1 Year experience in healthcare customer service role
• Skills: Excellent listening and communication skills including oral comprehension/expression and written correspondence required.
• The ability to understand and follow departmental and organizational policies and procedures.
• Excellent customer service skills to effectively communicate and interact daily with patients, vendors, payer sources, and guarantors. Internal contacts are made with, but not limited to, Medical Records, physician and/or hospital billing, Nursing, Information Services, Financial Counseling, Social Services, Executive Leadership, Legal, Compliance, Utilization Review, PHO, etc.
• Ability to work independently, exercising good judgment, and multi-task in a high stress, fast paced service environment with patients/guarantors, patient/guarantor representatives and insurance carriers.
• Ability to maintain professional conduct and good working relationships with staff, supervisors, and third-party vendors.
• The mathematical skills necessary to balance charges and payments and resolve discrepancies.
• The ability to multi-task and effectively manage workflow through automated processes.
• Detail oriented with good analytical problem-solving skills.
• Requires the ability to be empathetic, calm, patient, and professional when assisting customers during challenging billing dispute interactions.