District Operations Manager
The Field CSR interacts with patients, caregivers, medical professionals, insurance companies and internal departments to provide support for the organization’s Sales & Field Operations division. Individuals in this role will complete the final order verification process to ensure accuracy before submitting each item for billing. A keen attention to detail in processing high volumes of work is essential. The Field CSR must acquire and maintain a strong applicable knowledge of respiratory products, services and related procedures, as well as the requirements for their assigned locations to respond accurately to customer needs. Above-average clerical and multi-tasking skills with a strong sense of urgency are a necessity. CSR’s at this level may be assigned any combination of the responsibilities listed below and are required to assist their team in submitting patients’ paperwork for reimbursement. Position will be measured on productivity, performance metrics, as well as the quality and accuracy of work processed. Other operational projects and tasks may be assigned as needed. Maintaining confidentiality and all other aspects of HIPAA compliance are essential in this job.
DUTIES & RESPONSIBILITIES:
Effectively communicate with internal and external parties, including patients and insurance companies, via email, fax and phone.
Confirm patient information from new orders as they arrive in queue; prioritize incoming items according to product type and level of urgency.
Assist with obtaining all missing items for incomplete orders; redirect as needed.
Access insurance/payer websites to research guidelines and determine coverage.
Utilize Electronic Medical Records (EMR) applications to scan, access, catalog and review documents.
Access knowledge applications and reference tools to research information.
Represent assigned center locations in responding to a variety of concerns; maintain familiarity with site needs and state-specific documents.
Escalate urgent or unique concerns to immediate supervisor and provide support where appropriate.
Accurately reflect status in telephony system.
Train other employees on assigned functions and assist in quality assurance efforts.
Respond to email or notifications to proceed with submitted orders.
Review orders for accuracy; access internal systems to verify information and ensure documents are available in EMR application.
Contact patient/caregiver to obtain verbal confirmation of order and inform them of benefits coverage and any amount owed; cancel processing at patient request.
Submit C-PAP orders for payment.
Confirm payment type and notate account in system; complete appropriate forms for credit card transactions.
Accept any missing/replacement insurance information via phone and update account.
Inform patient that center staff will contact them for delivery and setup; create ticket in system.
Process Revenue rejections and provide missing items; create exception document cases and track through resolution.
Review prescription and account information and validate documents in EMR.
Work non-billing patient reports by creating new cases in SalesForce to obtain missing documents and get patients back to billing status.
Assist walk-in patients and customers as needed.
Accept incoming shipments and order supplies as needed.
QUALIFICATIONS & EXPERIENCE:
High school diploma/GED with three years previous customer service experience in a clerical setting, centralized operations or other office environment is required. College coursework or specialized training in a business or healthcare-related discipline is preferred.
Working knowledge of Medicare, Medicaid and private insurance is highly desired. Quality assurance experience is helpful.
Ability to multi-task and complete high volumes of work with an extremely strong attention to detail is essential.
Proficiency with Microsoft Office applications and data entry skills are required.
Must exhibit compassion for patients and a sense of urgency in solving problems.
Excellent written and verbal communication skills and the ability to interact effectively by phone and email.
Job may require occasional lifting of up to 25 pounds.
Approximately 15% of the workday will be spent walking/standing and the remainder, sitting.
Keyboarding is regularly performed 75% of the total time.
Up to 30% of the day may be spent interacting by phone.
Pacific Pulmonary Services is an Equal Opportunity Employer
Any offer of employment is contingent upon the results of a pre-employment drug test and background check.
The above job definition information has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job. Job duties and responsibilities are subject to change based on changing business needs and conditions.
Pacific Pulmonary Services (PPS) was founded in 1978 in Bakersfield, California, as "Med-Mart", a full-service durable medical equipment...