Customer Service Representative - Revenue Cycle Operations
West Virginia University Hospitals - Morgantown, WV

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Interprets and applies WVUH and UHA financial policies to make appropriate financial decisions and payment arrangements to ensure the financial viability of WVUH. Prepares and presents fee estimates to current and potential patients. Provides financial education regarding benefits to patient to assist in understanding their personal financial liability. Demonstrates the ability to assertively pursue necessary information and to function independently to secure financial resolution on accounts. Projects a mature problem-solving attitude while dealing with interpersonal conflict, dissatisfied patients and time demands. Maintains knowledge of revenue cycle operations, third party reimbursement, local/state/federal regulations and medical terminology. Knowledge will include at minimum, all aspect of payer relations, claims adjudication, contractual claims processing and general reimbursement procedures. Uses excellent customer service, written and oral communication skills.

Essential Duties and Responsibilities:

„X Interviews patient in person or by the phone who is referred for financial counseling in person or via the telephone to determine financial counseling needs and to help formulate a plan for financial resolution

„X Based on information provided by the patient an initial determination will be made if the patient has adequate benefits or qualifies for Medicaid, special programs or payment arrangements based on federal, state and hospital policy

„X Education will be provided to patient on their benefits, patient liability and/or the process for applying for Medicaid, completion of the financial statement and payment alternatives

„X Informs patients of hospital and clinic billing practices/policies and their rights and responsibilities regarding payments

„X Insured patients who are responsible for a balance after insurance will receive a preliminary financial overview and will be assisted in completion of the financial statement if necessary for financial resolution

„X Review completed financial statements and makes a determination based on hospital policy if the patient qualifies for a payment arrangement and documents in the registration/billing systems

„X Works with specialty departments to establish appropriate financial arrangements for elective services

„X Identifies and accurately resolves potential patient account issues for WVUH

„X Resolves billing questions for patients who present to the Inpatient or Chestnut Ridge patient services area

„X Monitors daily reports to identify large dollar account balances and private pay patients that need resolution

„X Refers patients to local, state and/or federal agencies for assistance

„X Displays an understanding of third-party payor regulations related to managed care, denials and reimbursement issues

„X Has a working knowledge of current hospital contracts with third-party payors

„X Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing

„X Collects deposits/co-payments/deductibles/patient liability payments when applicable, provides patient receipt and documents payment in the registration/billing systems

„X Balances daily receipts and cash drawer for patient payments, prepares and delivers deposit to cashier’s office

„X Follows up on accounts as indicated by system flags

„X Ability to accurately utilize applicable computer software and equipment for access processing

„X Initiates auto accident liability coverage. Identifies all patients involved in an auto accident and obtains all pertinent information regarding medical or non-fault liability and documents in registration/billing systems.

„X Initiates ERSD (end stage renal disease) screening. Identifies ESRD patients and obtains all pertinent information regarding coverage by SSI and documents in the registration/billing systems.

„X Initiates Veterans Administration eligibility screening. Identifies all VA eligible patients and coordinated admission/treatment with AV and documents in the registration/billing systems.

„X Initiates Black Lung SSI screening. Identifies all patients covered under Black Lung and documents in the registration/billing systems.

„X Initiates Workers Compensation screening. Accurately identifies all patients seeking treatment for work related injuries. Assists in completion of appropriate paperwork and documents in the registration/billing systems.

„X Initiates MSP (Medicare secondary screening). Obtains all information regarding MSP. Documents in registration/billing system all information required on the MSP form.

„X Demonstrates ability to follow established computer down time procedures.

„X Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.

„X Attends departmental meetings and/or documents review of meeting minutes.

„X Uses collection techniques which are legal and within hospital policy and procedure on a daily basis in all contacts while pursuing delinquent accounts

„X Maintains work que by reviewing payment status and contacts responsible parties by phone to arrange prompt payment of services

„X Reviews outstanding insurance accounts according to department procedures, to identify those past due for follow-up and contacts responsible payor and negotiates discount where applicable.

„X Investigates overpayments and takes appropriate action to resolve variance within thirty days of occurrence.

„X Complies with all reimbursement billing procedures of third party and private insurance payors according to department policy and procedures

„X Takes appropriate actions to resolve account issues for customers. Actions will include close consultations with other staff member, other hospital departments and payors.

„X Receives incoming phone calls and correspondence, ensures that accurate and timely communication and appropriate action are facilitated and that the department is presented in a positive manner.

„X Investigates and resolves special circumstances (i.e. charity care guidelines, extensive medical expenses implying catastrophic illness, bankruptcy notices, etc.) by consulting appropriate departmental and/or other authorized personnel on an on-going basis, as monitored by ability to ascertain appropriate course of action on patients’ accounts during on-going scheduled reviews as established in departmental procedures.

„X Review and analyze patient account information on an on-going basis to recommend suitable alternative settlement plans when adequate monthly payments are not realistic or patient is unable to maintain adequate terms.

„X Interprets situations or issue from customer, explains charges to patients, insurance companies, medicare, and other parties in a clear, concise, and professional manner.

„X Processes and researches mail returns, recommending disposition for those unable to trace.

General Duties and Responsibilities

„X Participates in performance improvement (i.e. follows established work systems, identifies deviations or deficiencies in standards/systems/processes and communicates problems to coordinator or manager)

„X Works with coordinators and manager to develop and attain quarterly objectives

„X Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information.

„X Is polite and respectful when communicating with staff, physicians, patients and families. Approaches interpersonal relations in a positive manner.

„X Complies with Notices of Privacy Practices, and the Patient’s Rights and Responsibilities.

„X All staff shall cooperate with the WVUH Corporate Compliance Program during their employment.

„X Demonstrate knowledge of procedure to report and/or document unsafe/hazardous conditions, incidents and defective equipment in compliance with hospital policy.

„X Complies with annual competency requirements related to Emergency Preparedness, hazards, blood borne pathogens, universal precautions, infection control, electrical/fire safety, material safety data sheets and any other topic deemed appropriate to assigned work areas.

„X Demonstrates flexibility to meet the needs of department or hospital in regard to changes in work volume, planned change, scheduling changes and emergency call-backs (i.e. weather or disaster)

„X Uses hospital communications systems (fax, beepers, telephones, duplicating equipments, scanners, pneumatic tube system and computers) in accordance with hospital standards

„X Communicates problems hindering workflow to management in a timely manner.

„X Explains consistently the hospital regulations.

„X Provides patients information concerning insurance, payment of bills and hospital procedures.

„X Communicates effectively verbally and in writing and places high emphasis on customer service. Receives and relays pertinent information to other members of the healthcare team.

„X Demonstrates the knowledge and skills necessary to communicate to the infant, pediatric, adolescent, adult and/or geriatric patient per the established age-specific education/standard.

„X Assesses all self pay patients for potential public assistance through registration/billing systems

„X Obtains commitment to pay from patients that do not meet requirements for public assistance or full charity write off.

„X Maintains current knowledge of major payor payment provisions.

Performance Standard

Employee will adhere to the established Performance Expectations for WVUH Employees in the areas of People, Service, Performance Improvement, and Shared Values & Culture.


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands

„X Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping and feeling are necessary body movements utilized in performing duties throughout the work shift

„X Must be able to sit for extended periods of time

„X Must have reading and comprehension ability

„X Must be able to read and write legible in English

„X Visual acuity must be within normal range

„X Must be able to communicate effectively

„X Must be able to exert in excess of 50 pounds of force occasionally to move patients or objects

„X Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment

Work Environment

„X Office type environment

„X Patient care environment

Knowledge, Skills and Abilities:

• Excellent oral and written communication skills

• Working knowledge of computers

• Basic knowledge of medical terminology

• Basic knowledge of third party payors preferred

• Basic knowledge of business math preferred

• Basic knowledge of time of service collection procedures preferred

• Basic knowledge of ICD-9 and CPT coding preferred

• Excellent customer service and telephone etiquette

• Must demonstrate the ability to use tact

Position Requirements
Minimum Qualifications

„X High school graduate or GED required

„X Two years’ experience in a healthcare setting preferred

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