Call Center Representative

Job Summary:
The Call Center Representative (CCR) is responsible for managing internal and external calls and completing job tasks surrounding the nature of the call while providing the highest level of customer service. He/she is responsible for adhering to Pivot’s policies and procedures, scheduling, accuracy of entering patient demographics, verification of insurance, and proper documentation of accounts. The CCR is flexible, adaptable to change and learning new skills. He/she possesses excellent customer service skills and acts as a liaison to the clinics, Clinic Director, Front Office Manager and Director of Front Office Operations. The CCR reports to the Regional Director, Revenue Cycle Management.

Essential Duties and Responsibilities:
Maintains and performs a warm, friendly and welcoming relationship with all patients, Pivot staff, all medical and non medical professionals, vendors and visitors. Individual must excel in the area of customer service

Adheres to Pivot’s policies, procedures, and core values

Clearly understands front office operations and performs these operations as presented in the FOC manual, Scheduling/Billing/EMR manual or any other manuals developed or deployed by management team

Attempts to maintain continuity of care when scheduling patient appointments

Efficiently and accurately uses any technology and any software required to complete his/her job or as required by management

Routinely completes all of HIPAA Privacy and Security training as required by Pivot management team and adheres to these privacy policies

Answers all inbound calls within third ring and will use Pivot’s greeting

Responsible for all components of scheduling appointments, setting up new accounts (demographics, insurance and case information) and properly documenting accounts as needed

Follows up with patients’ in a timely manner

Understands the importance of productivity in regards to scheduling and recapturing appointments

Has strong understanding of health insurance and be able to confidently explain benefits to the patient and answer front office questions

Documents workflows, keeps up to date with insurance changes and requirements of those carriers

Updates and adds appropriate supporting codes that are not in the database

Reviews encounters and utilizes coding edits in instances in which clinics are not staffed or in instances of outages as directed by management

Forwards calls to the appropriate party as needed (ex: billing, payment poster, collection reps)

Accurately verifies benefits via phone, ask detailed questions outside of what is provided, and set up accounts accurately

Ensures that all visits performed are properly authorized and make efforts to minimize the occurrence of any unauthorized visits

Utilizes websites only in instances in which the websites are relevant and approved by Pivot Physical Therapy. (ex: insurance websites for authorization, National Provider Identifier (NPI) websites, etc.)

Scans all patient documents within 24 hours of receipt; uses the appropriate naming convention of each document and scan the document to the appropriate case

Completes daily, weekly and monthly operations and reconciliations

Audits on each visit to ensure there is a valid prescription, proper authorization / referral / precertification. In instances where this is missing, CCR will follow up with the specific location.

Follows up and reviews daily reports and proactively follow up and communicate the need for a prescription, authorization / referral / precertification to ensure there are no delays with patient care. This should only occur in instances where there are system outages or in absence of front office representation.

Ensures that all “Plan of Cares” for Medicare are signed and returned by the physician within 30 days of the patient’s Initial Evaluation

Completes account audits to ensure accounts are set up correctly and have proper documentation

Reviews audit logs based on inbound and outbound calls

Maintain a neat and organized workspace and ensure cleanliness within the corporate office

Depending on phone volume, may be utilized for special projects

Participates in regular meetings and any other training as requested by management

Effectively manages his/her time in regards to hours worked and breaks and documents this information in the appropriate software daily

Submits expense reports in a timely manner as directed by management.

Utilizes Front Office Managers, Clinic Director’s, Billing and Director of FOC Operations as a resource for questions and to problem solve challenging situations.

Required Education, Skills & Abilities:
High School Degree or equivalent

Previous experience in an office environment, preferable in the health related field.

Excellent customer service skills, interpersonal and communication skills, including proper phone etiquette

The ability to manage his/her self and organize multiple priorities.

Excellent documentation skills,

Proficient in utilizing Microsoft Office, Word, Excel and all other technical or software systems

Ability to trouble shoot, strong sense of decision making and judgment; action oriented; approachable.

Team player and effective at building and fostering teamwork as well as maintain composure when dealing with conflict

Active listening skills and able to adapt to change.

Effectively manages time, timely decision making and manage priorities