The Reimbursement Resource Representative-CSR is responsible to provide support to patients, providers and customers internally and externally on billing related inquiries. The employee works insurance claims and patient accounts using department guidelines and MPG electronic systems. The position requires a thorough knowledge of insurance carrier billing and reimbursement, CPT, modifiers and fee schedule differences. Also requires understanding of how to decipher explanation of benefits and explain the impact to the customer. Position requires the ability to conduct both telephone and face to face meetings with patients regarding account resolution and payment collection as well as via portal messaging.

Assist customers with hardship applications, payment plans and eligibility for services. Expert verbal communication, interpersonal skills and professional appearance required for dealing with customers. Additional duties as required.

Job Standards:

• Demonstrate excellent interpersonal skills with patients, coworkers and insurance carriers.
• Well-versed with all HIPPA Guidelines to ensure the protection of patient information from unauthorized inquiries.
• Process and post payments to accounts same day
• Resolve patient complaints within a minimal timeframe, same day whenever possible.
• Meet timelines for reprocessing Athena claims after updating the account with new information as provided by patients or physicians within the guidelines and timeframes permitted by the insurance carrier.
• Advanced knowledge of cpt and modifiers
• Phones answered & voicemails returned within same day.
• Claim adjudication carrier rules knowledge
• Conducts themselves in accordance with MPG Policies and Procedures including the Code of Conduct.
• Meets or Exceeds monthly performance goals, expectations and reviews
• Uses Paid Time Off effectively
• Keeps overtime to a minimum/has any overtime approved by Manager
• Communicates call trends to managements when needed for possible escalation.
• Actively participates in team meetings and educational opportunities