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Customer Service Representative (L)

Customer Service | Emeryville, CA | Full Time, Contract, and Temporary

Job Description

Customer Service Representative 820531 (L)

The SBO Customer Service Representative has a thorough knowledge of the Medical Center and Medical Group insurance contracts as the unit deals regularly with complex policy and procedural issues that involve contract compliance with regard to HMO, PPO and government payers. The SBO/Customer Service Representative negotiates prompt payment discounts and sets up payment plans according to departmental guidelines. The SBO/Customer Service Representative has a working knowledge of the Medical Center discount and charity policy. The SBO/Customer Service Representative recommends accounts for collection agencies or return from Collections agencies. The SBO Customer Service Representative is responsible for responding to and following up on the patient’s high-dollar outstanding account receivable in a courteous and timely manner. The SBO Customer Service rep demonstrates the ability to process all customer service inquiries and to perform all aspects of follow-up with quality, compassion and assertiveness. The SBO Customer Service rep will conform to all Health, government, and HIPAA policies and procedures. SBO Customer Service Representatives utilize multiple databases and applications to analyze and take appropriate action on information or documents received. Applications and Databases consist of: Epic, Emdeon eCashiering, MS Outlook, MS Excel, Hospital Rates, Cirius, Imaging, MyQuote, Medi-Cal, Medicare, and other payer websites, SMS/LDA, IDX/LDA


  • Answer incoming telephone calls via the ACD telephone system within the timely standards defined by the unit following HIPAA mandated rules. Set ACD work status in accordance with activity on the phone. 
  • Respond and resolve inquiries, which may include, but are not limited to, explain patient and insurance billing policies and procedures, pricing, patient appeals, missing payment and quality of care issues for both hospital and professional services. 
  • Examines and evaluates accounts for appropriate follow-up action. 
  • Interpret and enter detailed on-line notes in order to understand past activity and to provide an audit trail for future follow-up, using appropriate SBO Note Type. 
  • Determine correct payer, when appropriate; such as Government, Non-Government, HMO, PPO, Worker’s Compensation, Research/Study and other payers. 
  • Navigate billing activities in EPIC (including MyChart Billing) with the patient through careful explanation and visual assistance; troubleshoot any issues and errors by offering callers step-by-step instructions. 
  • Determine eligibility for financial assistance following the established policy. 
  • Secure guarantor/patient demographic and/or insurance information and update/correct the on-line system as needed. 
  • Secure patient payments by collecting credit card information and process using portals such as Bluefin keypads and MyChart QuickPay. 
  • Calculate and post self-pay discounts, charity and contractual. 
  • Arrange payment plans towards total guarantor liability in accordance with guidelines. 
  • Prepare accounts for transfer to collection agencies. 
  • Maintain WQs as assigned. 
  • Initiate Charge correction request. 
  • Research missing payments by reviewing Epic, EOB (Explanation of Benefits), IDX/LDA, SMS/LDA, and Imaging. Review and process payment transfers. 
  • Retrieve all required information needed in order to evaluate credit balances and/or correct refund payee. 
  • Complete and submit refund requests with detailed back up to management for approval. 
  • Submit requests to departments/clinic via RFI process for review response and appropriate action. 
  • Retrieve voice mail messages and returns all phone calls within the timely standards defined by the unit. 
  • Retrieve electronic mail messages and respond within the timely standards defined by the unit. 
  • Utilize knowledge of various systems including, but not limited to:
    • Epic, MS Outlook, MS Excel, Hospital Rates, Cirius, Imaging, MyQuote, Medi-Cal, Medicare, and other payer websites, and any other information systems which would be required for insurance eligibility, benefit verification or other information needed for follow-up 
    • Provide back-up for the Correspondence Unit, as needed, in accordance with departmental procedures. 
    • Notify the manager of issues that affect performance improvement. 
  • Mentor and assist in training new employees. 
  • Attend department, unit, and other meetings as required. 
  • Perform other duties as assigned.


  • Minimum of 4 years of experience in a hospital billing, physician billing, or payor office environment.
  • High school graduate or GED certificate.
  • Must demonstrate an in-depth understanding of all aspects of billing procedures consistent with those performing insurance follow-up activities both hospital and professional billing environments.
  • Working knowledge of contracts, insurance billing requirements, UB04 and HCFA 1500 claim forms, Workers’ Compensation, HMOs, PPOs, capitation, Medicare, Medi-Cal and compliance program regulations.
  • Working understanding of CPT, ICD, DRG, and HCPC codes.
  • Excellent interpersonal, verbal, and written communication skills.
  • Ability to demonstrate cultural sensitivity and a respectful, courteous and professional manner in all interactions, especially a “high stress” one of the patient complaints
  • Ability to balance assertiveness with compassion, empathy, and patience for the patient and others.
  • Good analytical and organizational skills.
  • Must be a motivated individual with positive and exceptional work ethics.
  • Ability to follow directions and written procedures.
  • Thorough knowledge of computer operation, keyboard functions, calculator, copier and fax machine operation with standard keyboard skills.
  • Computer software skills (i.e. Microsoft Applications and E-mail, etc.)
  • Thorough understanding of HIPAA rules and regulations.

Preferred Qualifications:

  • Bachelor’s Degree
  • Prior work experience in a customer service or call center environment 
  • Working knowledge of electronic billing systems, preferable EPIC.
  • Working understanding of stop losses, per diems, carve-outs and other contract terms and conditions.

$25 per Hour      Emeryville, CA 94608       7 Month Assignment