1 ST. JOSEPH'S HOSPITAL AND HEALTH CENTER Customer ...

1
ST. JOSEPH’S HOSPITAL
AND HEALTH CENTER
Customer Service Representative
Job Title: Customer Service Representative Department: Admissions
Classification: Non-Exempt
Reports to: Supervisor, Admissions
Position Summary: The Customer Service Representative is responsible for: ensuring the delivery of
outstanding customer service while: obtaining complete and accurate patient demographic, insurance, financial
information and collection of co-pays; patient benefits/eligibility; financial counseling; referrals/preauthorizations/pre-certifications
approvals from insurance companies and physician offices and pre-registration
of visits. This position is also responsible for assisting patient scheduling when needed.
Security Access: High - “Incumbent has access to restricted or confidential patient information and must
comply with the terms of the St. Joseph’s Hospital & Health Center Security Policies as it applies to their job
role.”
PRINCIPAL DUTIES/RESPONSIBILITIES:
1. Establishes and maintains effective working relationships and outstanding customer service skills.
2. Meets the expectations and requirements of internal and external customers.
3. Acts with customers in mind.
4. Establishes and maintains effective relationships and gains customers’ trust and respect.
5. Develops positive working relationships with customers through responsiveness and delivery of accurate,
timely and effective services.
6. Exhibits effort and follow-through in resolving customer problems and needs in a timely manner or keeps
customer frequently abreast of development and status of issue.
7. Brings resolution to issues on a timely basis and within policies or established standards.
8. Accurately pre-admits and/or admits all patients with concern for specific age, insurance/managed care
issues, and financial reimbursement for patient services on date of appointment.
9. Accurately registers and enters correct demographic, insurance, and billing information into hospital ADM
system.
10. Ensures appropriate consents and Medicare/JCAHO requirements are signed timely by the patient for all
levels of care.
11. Provides Patient Rights, Advance Directives, Notice of Privacy Practices, and adheres to EMTALA
requirements.
12. Ensures necessary insurance verification/referrals/authorizations and co-pays have been obtained.
13. Separates face sheets, gives patient wristband, and distributes patient charts per department protocol.
14. Explains financial requirements to the patient or responsible party, collects deposits/co-payments as
required and reconciles daily deposits.
15. Prints the “Unprinted Bills” report daily from B/AR and works accounts missing authorizations and/or other
patient demographic/insurance information to completion in a timely and efficient manner.
16. Works in coordination with the CBO Billing Compliance Coordinator on any accounts that are identified as:
Self Pay Pending, Medicaid Pending, W/C Pending and Auto Accidents.
17. Reviews patient “out-of-pocket’ amounts and/or “Self-pay” balances and contacts patients/guarantor
regarding payment options for Scheduled inpatient, surgery, observation, KDU, MRI and CT’s.
18. Counsels patients and families regarding financial issues such as insurance and eligibility for assistance.
Assist them in completing Financial Aid applications and working with Director for final approvals.
19. Processes Financial Assistance by adding the appropriate Charity insurance; county notices and Bankruptcy
notices (these are forwarded to the CBO).
20. Coordinate and communicate with the CBO on any changes to patient information that may affect billing
and collections. This could be through Meditech comments, B/AR or phone.
21. Conducts in-house patient interviews and completes any information missed at the admissions desk such as
MSP’s.
22. Constructs clear and concise documentation on the patients account.

23. Responsible for detailing verification/benefit/authorization information into the ADM/BAR system: i.e. group
names, group numbers, policy numbers, deductibles, co-pays and authorization information.
24. Assists in reviewing Admission Face Sheets for complete and accurate third party billing information and
promptly correct if necessary.
25. Utilize Meditech Verification Work-list for non-verified accounts on a daily basis.
26. Coordinate with the Denials Management Coordinator on any denials/errors received regarding
authorization or verification.
27. Has a basic understanding of the various scheduling systems to know when patients are arriving and where
they need to be seen for services.
28. Directs and/or escorts patients to care where services are to be delivered.
29. Responsible for working Returned Mail according to departmental guidelines.
30. Works in conjunction with Supervisor to provide support and backup coverage as needed.
31. Assists with training of staff when deemed appropriate by Supervisor.
32. Communicates with insurance companies, health maintenance organizations, managed care contract
companies and other third parties to obtain insurance verification data and pre-certification approval for
admissions; maintain liaison with physicians, nurses and administrative staff to resolve problems and to
address interdepartmental complaints.
33. Conducts patient transport activities including transport by wheelchairs, stretchers and/or van/valet service.
Coordinate information services provided by patient information desks and clinical customer services.
34. Ensures compliance with standard St. Joseph’s policies relating to patient registration, scheduling, insurance
verification and billing.
35. Timely and accurate posting of all self-pay payments received on site, including balancing to local bank
deposit slips.
36. Reporting of all patient compliant detail to CBO.
37. Assistance with the research and resolution of complaints and systematic service problems.
38. Communication of all special payment arrangements to CBO.
39. Performs other duties as assigned.
BASIC FUNCTIONS:
A. Demonstrates excellent customer service performance and displays a positive attitude and behaviors
consistent with the CHI Standards of Conduct and Core Values.
B. Actively supports and participates in quality improvement.
• Participates in quality teams and unit activities.
• Applies in safe and proper manner correct body mechanics, proper transfer techniques, BSI
techniques, chemical usage and other hazardous materials, and use of equipment.
• Takes immediate action in unsafe situations.
• Uses down time to benefit the department and SJHHC.
• Investigates and reports patient, staff and visitor incidents immediately in appropriate manner.
• Understand role and follows procedures in all codes and drills.
• Adheres to all hospital and departmental safety standards thus promoting safety practices to ensure
a safe and healthful environment for patients, staff and visitors
C. Demonstrates and supports the CHI Standards of Conduct, Core Values and Policies and Procedures of the
Hospital.
• Exercises good faith and honesty in all dealing and transactions. (Integrity)
• Creates a workplace that fosters teamwork, respects the inherent dignity of every person, promotes
employee participation and ensures safety and well-being. (Reverence)
• Provides accurate and truthful information in all transactions. (Integrity)
• Maintains and protects the confidentiality of patient, employee and organizational information.
(Compassion)
• Exercises responsible stewardship of both human and financial resources. (Compassion)
• Avoids conflicts of interests and/or the appearance of conflicts. (Integrity)
• Uses tact, sensitivity, sound judgment and professional attitude in communication and relationships
with others. (Compassion)
2

3
• Strives to deliver the best quality care and service. (Excellence)
• Promotes a positive image of the hospital and its services.
• Is timely and punctual in attendance and follows all policies and procedures.
QUALIFICATIONS:
Education:
Work requires a minimum education of a high school diploma or GED.
Experience:
Work generally requires two years of experience in a health care setting
involving customer service to become knowledgeable in practices involved in
patient admissions and financial counseling, billing and collections, and/or
coordination of services related to insurance verification, bed control, patient
information and transport. OR AN EQUIVALENT COMBINATION OF RELEVANT
EDUCATION AND/OR EXPERIENCE. Strong computer skills required, prefer
experience with Meditech and Microsoft Office.
Physical Demands of Position (Below is an example):
During a normal work day, an employee working in this position needs to perform the following demands of the
essential functions of this position as observed and measured by a WorkSTEPS Certified Physical Therapist.
Variations from the Dictionary of Occupational Medicine (DOT) have been derived from on sight analysis.
EMPLOYEE/PATIENT
MUST
NEVER 1 – 33%
OCCASSIONALLY
34 – 66%
FREQUENTLY
67-100%
CONTINUOUSLY
Lift up to 50 lbs.
Floor to Knuckle;
X
Source: DOT
Examples: Assisting a 200 pound person into a sitting position from supine. Assisting with sit to stand transfers. Assisting
a client up from the floor with assist from other staff and appropriate tools. Total Assists of clients weighing more than 200
pounds will require additional staff.
Life up to 40 lbs.
X
Knuckle to shoulder.
(laundry bags)
Shoulder to
X
overhead 12 lbs
Example: Preparing IVs, reaching clean laundry from the storage closets. Books that weigh as much as 12 pounds have
been measured. IV solutions weigh less than 5 pounds.
Push/Pull (see force
X
below)
Example: Up to 40 lbs start force and 25 lbs mean sustained force when on carpet with 200 lbs on a cart. Up to 30 lbs
start force and 15 lbs mean sustained force when on tile with 200 lbs on a cart.
Climb Stairs
X
Walk
X
Sit
X
Stand
X
Twisting upper body
X
NOTE: Twisting is discouraged with use of proper body mechanics but is performed occasionally during patient care.
Squat/Kneel
X
Bend/Stoop/Crouch
X
Use Hands
X
Dexterously
Examples: (Pincer grip) preparing medications, writing, typing.