PAR-CUSTOMER SERVICE REPRESENTATIVE - Tri City Healthcare District

Tri-City Medical Center has served San Diego County’s coastal communities of Carlsbad, Oceanside and Vista, as well as the surrounding region for more than 60 years and is one of the largest employers in North San Diego County. Tri-City is administered by the Tri-City Healthcare District, a California Hospital District. As a full-service acute care public hospital with over 500 physicians practicing in over 60 specialties, Tri-City is vital to the well-being of our community and serves as a healthcare safety net for many of our citizens. The hospital has received a Gold Seal of Approval® from the Joint Commission showcasing a commitment to safe and effective patient care for the residents of the community. 

Tri-City Medical Center prides itself on being the home to leading orthopedic, spine and cardiovascular health services while also specializing in world-class robotic surgery, cancer and emergency care. Tri-City’s Emergency Department is there for your loved ones in their time of need and is highly regarded for our heart attack and stroke treatment programs. When minutes matter Tri-City is your source for quality compassionate care close to home. Tri-City partners with over 90 local non-profit and community organizations as part of our COASTAL Commitment initiative. Together we are helping tackle some of our communities’ pressing health and social needs.

Position Summary:

Receive, answer and/or record telephone/correspondence inquiries from subscribers and participating providers relating to areas of coverage and payment of claims for Tri-City Medical Center, District Hospital. Responsible for providing assistance to the Patient Accounting Department (PA) and staff with regard to incoming calls, inquires, correspondence, making patient collection calls, bad debt assignment of community service, charity care, return mail and other clerical duties. Demonstrates extraordinary commitment to excellence by adhering to departmental excellence criteria.

Major Position Responsibilities:

The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization.

• Maintains a safe, clean working environment, including unit based safety and infection control requirements.
• Responsible for receiving incoming calls to PA and making calls to patient within the alpha and dollar amount assigned to the representative.  Replies to all patient and client calls within 48 hours from the call.
• Responsible for an alpha split of accounts with a 0 to $5000 threshold, assigned a collector number to which these accounts are assigned.  Responsibility of these accounts are tracked weekly and monthly for the CSR to meet the department goals.
• CSR is responsible for reviewing and recommending accounts to be reviewed for payment arrangements through Health Cash, bad debt or community service options. CSR is responsible for all follow up on Health Cash arrangements monthly to ensure patient is current on the invoice.
• Perform research and correspondence functions to assist with responses to customer and insurance company inquiries. Recognize and relate problem service issues to Management.  Perform related claims approving and clerical work as assigned.
• Responsible for documenting bad address information, when return mail is received, in the Patient Accounting System notes.   If new address information is received, the accounts will be updated and letters will be resent to the new address.
• Responsible for requesting files/EOB’s from storage and coordinating the return of batches back to storage.  This will include COA’s, inpatient jackets, cash sheets, etc.  Responsible for labeling all boxes, which contain the completed insurance verification jackets.
• Responsible for working with outsourcing agencies to obtain requested information.

Qualifications:

• Requires at least one-year experience in a healthcare environment and a thorough understanding of medical terminology.
• Able to perform basic mathematical calculations, balance and reconcile numbers.
• Ability to speak fluently in a foreign language is a plus.  Must have the ability to read, understand and interpret correspondence from a health insurance plan. 
• Must be able to work under pressure, handle stressful situations effectively and deal politely with subscribers and providers, both on telephone and in lobby interviews.
• Ability to speak well on the telephone and maintain a positive telephone personality.
• Must be able to compose clear concise letters, designated, sort and screen correspondence receipts and resolve via coding of additional payment.
• Ability to adapt to change and effectively perform duties in a multitask environment.
• Requires typing skills of 35WPM, requires data entry experience, Microsoft Word, Excel, and Outlook knowledge.
• Excellent human relations’ skills including listening, conflict resolution, coaching, and team building.
• Must have ability to demonstrate flexibility in response to unexpected change in work volume and hospital staffing needs.
• Process oriented skills with ability to handle multiple projects simultaneously by prioritizing responsibilities and meeting deadlines required.
• Ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents required.

Education:

• High School education, with some medical insurance background, preferred.

Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work. 

*Salary/Hourly wage range for this position is posted.  Actual pay will be determined based on verified experience as well as internal equity.

TCHD is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with a disability.