Member Services Representative, Sr. jobs in Springfield, MA

The Patient/Financial Services Representative is responsible for all insurance benefits, pre-authorizations, ad authorizations for patients at CARS requiring treatment and medications. They must be knowledgeable in all financial programs offered at CARS, and responsible for monitoring all patient accounts.

Major Duties [included but not limited to]:

• Responsible for pre-certifying all services scheduled for the assigned team physician. This includes: all IUI, IVF, TEST, MESA, FET, Embryo biopsy for PGT-A and PGT-M, DER, Donor Embryo, and Gestational Carriers cases. Areas covered in the precertification are: initial visit, treatment plans, medications for all of the above programs, following practice guidelines for pre-certifying (goal of 2 weeks before cycle start) notify patients of coverage and/or of self-pay arrangements. Also included are services for andrology, sperm and embryo storage. In regards to the established patient, testing such as HSG, sonohystograms, semen analysis, bone density tests and mammograms. MRI authorizations, pregnancy ultrasounds and endometrial biopsies, in office hysteroscopies and in office D&C would also be included.
• Surgical scheduling (i.e. hysteroscopy, D&C) for the team physician- pre-certifying surgical procedures if applicable, along with scheduling a pre and post-operative visit if required. This includes coordinating schedules with the Farmington surgical center and JDH surgical scheduling, sending over pre-op forms and providing FSC/JDH with benefit/auth info for each patient.
• Communicates the financial clearance of the patient to office staff nu utilizing Athena to dictate the terms of the financial arrangements which includes authorization from insurance company if coverage is obtained or detailed instructions for the self-pay patient (details should include amounts and timing of collection). Financial clearance is then given in RESource to update the clinical team.
• Completes CHARGE ENTRY on all IVF cycles for team physician. Charge entry is required to be done on a daily basis and in a timely manner (goal is end of the month). Monitors and maintains accounts through the cycling phase with final entry and review at the end each cycle. Also monitors balance due on team physician by reviewing accounts with patients. FSR’s should also monitor doctors’ and Ultrasound schedules daily and place appropriate notes in “quick view” to alert PSRs (schedules) to collect at check in/ check out as well.
• Regular follow up with patients to ensure payment of outstanding co-payments, balances, co-insurance, etc. (reviewing schedules for Doctor/cycling patients on a daily basis) and communicating appropriately.
• Reviews consents on patients’ account to keep them accurate and up to date.
• Maintains a strong rapport with the Central Billing Office (CBO), follows up on reports sent regarding auth issues, open consent lists, and communicates with CBO staff for guidance and assistance regarding challenging cases/issues. Provides refunds and adjustments to the patients via the CBO.
• Responds to all patient inquiries, via either phone, email, or in person regarding their account and insurance related matters.
• Communicates via Virtual Assistants as needed in regards to benefit check status.
• Responsible to cover the PSR/FSR positions for absences, vacations, or any other requested time off. Travel may be required.
• Reviews team physician schedule according to practice rules. Review schedule 2-3 days out for openings/issues and coordinate with PSR to keep schedules full and orderly.
• Understands the requirements associated with HIPPA and Confidentiality for all patients.
• Documents thoroughly, clearly, and accurately to ensure other staff can understand the status of a patient’s account.
• Willing to support and train new FSR’s as needed to encourage a team driven work environment.

Job Qualifications

Knowledge, Skills, and Abilities:

• Knowledge of the principles and practices of clinical office management
• Proficient in computer skills to maintain patient information and accounts
• Ability to professionally discuss financial agreements of patient treatment plans
• Ability to multi-task, manage, and prioritize flow
• Knowledge of medical terminology
• Experience and commitment to outstanding customer service skills
• Knowledge of basic information regarding the CT State Mandate for reproductive care
• Understanding of all financial programs offered by CARS including: LIVE Strong program, Possibility Plans, and Financial Share program
• Comprehension of CAPEX MD loans and Future Family Loans
• Must be detail oriented with excellent organizational and communication skills
• Support mission and vision of CARS
• Demonstrate ability to function successfully in a team environment

Required Qualifications:

• Demonstrated experience with outstanding customer service skills
• Minimum 1-2 years of specialized experience with healthcare insurance products and customer service in a provider setting
• Medical Software program experience
• Proficient in CPT, ICD-10 coding
• Working knowledge of Microsoft Office Products: Word, Excel, PowerPoint, Outlook, etc.

Preferred Qualifications:

• OB/GYN physician office experience
• Infertility office experience
• Passion for Women’s health/ fertility
• Customer service training/ experience

Fringe Benefits:

• Paid vacation and holidays
• Medical, dental and vision Insurance (available first month after start date)
• Flexible spending account and health savings account options (partially funded by practice)
• 401(k) retirement plan with match [after 90 days]
• Employer-paid short-term and long-term disability insurance
• Employer-paid basic life insurance [1x annual salary]. Additional supplemental life insurance available