Contact Center Specialist I

Contact Center Specialist

Gastro Associates is seeking a dedicated and customer-focused Contact Center Specialist to join our team. This position is responsible for answering incoming patient calls and scheduling office appointments across our four office locations. As the first point of contact for patients, you will provide essential support for scheduling, general inquiries, and coordination with clinical teams. This role will work Monday through Friday daylight hours 8am to 4:30pm.

This role begins as onsite to ensure comprehensive orientation and training, with the possibility to transition to a hybrid work schedule following successful completion of the onboarding period.

Responsibilities:

• Review, verify and enter the patient's demographic and insurance information to ensure data integrity.
• Answer multi-line telephone system and schedule appointments, contact or page physicians according to department questionnaires, protocols and templates.
• Understand UPMC 72-hour appointment requirement and work to ensure guidelines are met while still placing the patient with the right sub-specialist whenever possible to avoid return visit to see the correct sub-specialist.
• Complete follow-up on unpaid account balances. Contact guarantors, third party payors, and/or other outside agencies for payment of balances due.
• Identify and take action towards resolution of problematic accounts through potential refunds, adjustments, payment transfers, etc. to bring balance to zero. Adhere to Fair Debt Collection Practices Guidelines and understands the laws and regulations applicable to job functions.
• Contact patients to discuss their post-discharge appointment requirements; follow up and coordinate all appointments for the patient.
• Demonstrate the ability to understand the reason for a consumer referral call. Use decision making ability to appropriately refer a physician, class or program to meet the consumer's needs.
• Establish reasonable payment plans according to department policies; set up payment arrangement in system and monitors payments for consistency and timeliness. Counsel patients on various local, state and federal agencies, which may be available to assist with funding of health care.
• Identify, review, and research credit balance accounts, potential refunds, adjustments, payment transfers, etc., to bring the account balance to zero.
• Document all actions taken on a patient account. Review on-line account history and EOB's to ensure all payers have been billed and to validate the accuracy of payments and adjustments posted.
• Research, resolve and respond to email, web and telephone billing inquiries from patients and insurance carriers in accordance with departmental protocols.
• Demonstrate the ability to understand the reason/needs for the patient or clinicians call and apply the decision making ability to page or contact the appropriate physician to meet the patient's needs.
• Review and take action on accounts on aged trial balance reports or in assigned work queue meeting specified dollar and age criteria to ensure lowest number of days possible on accounts receivable. Assign accounts deemed un-collectible to external collection agencies on a monthly basis.

Qualifications:

• High school graduate or equivalent.
• 2 years customer service experience or call center experience required.
• OR 1 year health insurance call center and claims adjustments experience required.
• Detail Oriented.
• Advanced knowledge of health insurance, third party payor billing requirements, medical terminology and reimbursement practices preferred.
• Must be able to maintain confidential information.
• Excellent organizational, interpersonal and communication skills.
• Competent in MS Office/PC skills
• Must be able to make appropriate decisions based on the circumstances as well as established protocols.
• Must have strong interpersonal, organizational, and communication skills and be able to remain professional and courteous when dealing with sensitive issues and stressful circumstances.
• Licensure, Certifications, and Clearances:
• Act 34
• UPMC is an Equal Opportunity Employer/Disability/Veteran