Customer Service Rep (Patient Account Rep 1)

To primarily perform electronic customer service duties to ensure that monies due University Hospital are secured and paid in a timely manner and the AR outstanding days of revenue are kept to a minimum. Assignment will be flexible depending on payor mix, patient flow, and workload fluctuations.

• Submit bills that comply with all appropriate regulations, managed care contracts to third party payors.
• Calculate the correct reimbursement of all managed care claims.

• Within the stratified processing environment, collect assertively and proactively money due to OHSU by contacting (through telephoning, emailing, and/or accessing on-line systems) third parties (insurance carrier, various government programs, etc.).
• Provide explanation of charges and additional requested information to the third parties.
• Analyze accounts to determine coordination of benefits, refunds, and denials to insure appropriate resolution of accounts.
• Review billing to determine medical records necessary to provide complete processing of claim.
• Analyze accounts with regard to billing and payment history and uses judgment to determines appropriate follow-up action based on departmental guidelines.
• Contact patient/guarantor to resolve issues. (includes tracing and locating patient/guarantor by telephoning and/or sending written correspondence.)
• Analyze accounts and interpreting contracts that dictate how claims should be paid and processing adjustments for contract interpretation. 
• Comply with special billing and follow-up requirements regarding adoptions, court holds, motor vehicle and personal injury accidents, and other unique or sensitive accounts.
• Work reports of denied claims to trend and report these claims to the department and to our front end partners.
• Work closely with admitting, care management and ambulatory services on the denied claims for resolution and feedback purposes.
• Prepare the appeals for selected denials.

Other duties as assigned.

• Two years of recent (within the last 5 years) experience billing or collecting healthcare accounts in a business office; OR

• Four years of general collection, billing or customer service experience; OR

• Equivalent combination of education and experience. 

• Certified Revenue Cycle Specialist (CRCS) is required within 18 months of hire.

• 2 years of medical collection and/or billing experience within five years of the date of hire.
• 1 year of recent medical collection and/or billing experience within five years of the date of hire.
• Recent (within one year of date of hire) Microsoft Office Suite experience in Windows environment with skill in document production using WORD, spreadsheet construction in EXCEL.
• Experience in billing Hospital claims or UB-04 claims.
• Knowledge of and experience in interpreting managed care contracts.
• Familiarity with DRG, CPT, HCPC and ICD-10 coding.
• Typing 45 wpm.
• Ability to use multiple system applications.
• Demonstrated ability to communicate effectively verbally or in writing.

Monday through Friday. This is a hybrid position – in office and remote.

Deal with hostile, grieving or angry people on a daily basis.

 

We are Oregon's only public academic health center. In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. All are welcome. OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact askhr@ohsu.edu