Central Maine Healthcare Looking for Customer Service Representative at Lewiston, ME Full Time

At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.

Position Summary: The Customer Service Representative is responsible for all communication and research regarding patient accounts, as well as for responding to all patient inquiries for the regional healthcare system. This is a highly visible position with limited flexibility. The representative’s workflow is dictated by call volumes.

Duties and Responsibilities:

Demonstrates Competency in the Following Areas:

1. Projects a positive image of the department and organization as the first line of contact with patients regarding their financial services

2. Interacts daily with patients regarding billing problems, insurance information, payment data, etc., and applies resolution on established standards and reference guidelines by demonstrating the ability to assist patients and insurance companies with billing questions and problems.

3. Interprets billing questions and provides clarification by developing and maintaining a working knowledge of services offered.

4. Demonstrates ability to assist patients/families with third party billing questions and routes calls appropriately when necessary.

5. Listens and responds to customer service needs with the appropriate level of urgency.

6. Develops and maintains rapport with insurance payers, outside agencies and other departments within the regional healthcare system.

7. Updates patient accounts based on verified information from the patient/guarantor

8. Prepares correspondence to patients, attorneys, and insurance payers, (i.e., itemized bills, etc.) as necessary within 2 business days.

9. Processes patient requests for financial assistance, within 2 business days.

10. Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage; ensures confidentiality of patient records.

11. Sets up payment arrangements for patients/guarantors according to established guidelines and transfers these accounts to Advanced Collection Services (ACS) or the Self Pay Representative, as appropriate

12. Processes address changes as notified from ACS and return mail notifications

13. Records appropriately detailed notes on the patient account or guarantor following each call.

14. Reviews Patient Statements for errors and notifies supervisor when necessary

15. Communicates clearly and accurately with the Supervisor.

16. Follows through, in a timely manner, on all action steps requested by supervisor.

17. Meets stated performance standards for call duration, work time per call and call volume.

18. Achieves a Quality Review score of 2.8 or better, 90% of the time.

19. Handles all internal and external customer service matters in a timely, professional, confidential and appropriate manner

20. Adheres to department protocol and Central Maine Healthcare policies and procedures.

21. Demonstrates the ability to be flexible and organized and function well in stressful situations.

22. Provides coverage for other team members when necessary, reorganizes workflow as necessary to accomplish this.

23. Assists with projects and other assignments when necessary, offering assistance when possible.

24. Acts as a resource to the entire Customer Service team, providing training and support as necessary.

25. Processes and completes all job responsibilities in compliance with regulatory requirements.

26. Customer Service: Interacts with all individuals in a consistent manner, providing attention, support, and assistance to foster an environment of exceptional personal service.

a. Maintains a pleasant and helpful demeanor, and presents a professional appearance toward all internal and external customers at all times.

b. Consistently initiates interaction to provide assistance to individuals who may not be direct customers of the employee (i.e. asks patients who appear to be lost if they need assistance in finding their way).

c. Takes appropriate action to recover from a service difficulty, ensuring that the necessary action is taken to affect a resolution to the customer’s problem.

d. Conducts all work activities with respect for coworkers, including the maintenance of a pleasant and professional environment, fostering calmness during stressful situations.

e. Interacts with supervisory personnel in a professional, supportive and courteous manner, venting emotions appropriate to time and place.

f. Demonstrates a commitment to service by consistent attendance and punctuality, scheduling absences according to departmental requirements, and incurring unplanned absences only when unavoidable circumstances exist.

Organizational Requirements:

27. Adheres to departmental dress code, appearance is neat and clean.

28. Completes departmental and organizational annual education requirements.

29. Reports to work on time and as scheduled, completes work within designated time.

30. Wears identification while on duty, .

31. Uses computerized punch time system correctly.

32. Completes in-services and returns in a timely fashion.

33. Attends annual review and department in-services, as scheduled.

34. Attends at least 90% of all staff meetings annually

35. Represents the organization in a positive and professional manner.

36. Actively participates in performance improvement and continuous quality improvement (CQI) activities.

37. Complies with all organizational policies regarding ethical business practices.

38. Communicates the mission, ethics and goals of the organization, as well as the focus statement of the department.

39. Confidentiality: Maintains confidentiality of information at all times.

a. Consistently maintains confidentiality of all information gained during the course of employment, respecting the privacy of others.

b. Understands and maintains the confidentiality of information communicated directly from the supervisor, including discussions of a counseling nature.

c. Follows policies and procedures related to medico legal matters, including confidentiality, amendments of medical records, patient rights, medical records as legal evidence and informed consent

d. Copies records according to policy, assuring the appropriateness of the individual requesting information from the record prior to copying, faxing, or phoning any portion of the record.

40. Safety: Demonstrates an understanding of fire and electrical safety, infection control, body mechanics, and related areas, as appropriate to position.

a. Attends mandatory in-services on fire safety, electrical safety, infection control, and body mechanics. Successfully completes competency-based training in each area.

b. Follows all employee health procedures, incident reporting, and infection control requirements at all times, as appropriate to the position.

c. Uses proper body mechanics at all times as required by the physical demands of the position.

d. Maintains a safe work environment and performs duties of the position in a manner consistent with ensuring the safety of self and others.

e. Identifies safety needs in areas outside own work environment, recommending corrective action as appropriate.

41. Expense Control: Performs job duties in a manner that maximizes expense control.

a. Uses supplies, equipment, and utilities in an expeditious manner

b. Consistently recommends methods to control costs while maintaining a high degree of customer service.

c. Performs job tasks efficiently and effectively resulting in no unplanned overtime.

Regulatory Requirements:

• High School graduate or equivalent.
• Minimum of two years relevant experience, including knowledge of insurance billing and medical terminology
• Understanding of various insurance plans, government agencies, Medicare and Medicaid.

Language Skills:

• Able to effectively communicate in English, both verbally and in writing.
• Additional languages preferred.

Skills:

• Basic computer knowledge.
• High level of interpersonal communication skills.
• Ability to handle difficult customer situations.

Physical Demands:

• For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising client care.

If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!