Sysgen RPO, Inc.
• Essential Duties and Responsibilities • Patient Billing Support • Answer inbound calls regarding behavioral health billing inquiries. • Explain patient balances, copays, deductibles, coinsurance, and out-of-pocket responsibilities. • Educate patients regarding insurance processing and Explanation of Benefits (EOB). • Accept payments via approved payment methods following PCI-DSS requirements. • Establish payment plans according to organizational guidelines. • Explain financial assistance options when applicable. • Document all patient interactions accurately within the electronic medical record (EMR) and billing systems. • Insurance Eligibility & Benefits Verification • Verify active insurance coverage for behavioral health services. • Behavioral health benefits • Deductible status • Out-of-pocket maximum • Telehealth benefits • Visit limitations • Authorization requirements • Referral requirements • Network participation • Identify Coordination of Benefits (COB) issues. • Update insurance information in the practice management system. • Communicate benefit information accurately to patients and internal staff. • Claims Support • Research claim status using internal verification system • Explain claim processing outcomes to clients. • Review denied or pending claims. • Identify common denial reasons, including: • Eligibility issues • Authorization not obtained • Coordination of Benefits (COB) • Non-covered services • Timely filing • Incorrect patient information • Duplicate claims • Route/escalate unresolved claims to the appropriate billing or follow-up team. • Assist patients in understanding payer determinations. • Provide education regarding: • Prior authorization requirements • Benefit exhaustion • Session limitations • Medical necessity determinations • Insurance-specific behavioral health policies • Customer Service • Deliver compassionate and professional customer service to patients seeking behavioral health services. • Demonstrate empathy while maintaining professionalism. • Resolve inquiries during the initial call whenever possible. • De-escalate difficult conversations effectively. • Maintain confidentiality and sensitivity regarding behavioral health treatment. • Documentation • Accurately document: • Call summaries • Eligibility verification results • Benefit details • Claims research • Payment arrangements • Insurance updates • Patient communications • Ensure documentation meets organizational quality standards. • Maintain compliance with: • HIPAA Privacy and Security Rules • CMS billing regulations • Commercial payer guidelines • Medicare requirements • Medicaid requirements • Behavioral health documentation standards • Company policies and procedures • Safeguard Protected Health Information (PHI) at all times. Qualifications • High School Diploma or GED required. • Minimum of 1 year of healthcare customer service or medical billing experience. • Experience with behavioral health billing preferred. • Experience in an inbound healthcare call center preferred. • Experience with insurance verification and benefit interpretation preferred. • Ability to manage a high volume of inbound calls while maintaining quality standards. • Able to work in a shifting schedule covering EST, CST, MST PST, HI and AK business hours.
Sysgen RPO, Inc.
