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Customer Service Representative

Thrive Physical Therapy
Job Description
PURPOSE:
The Customer Service Representative’s (CSR’s) primary purpose is to provide exceptional customer service to patients and providers, while assisting in the growth of the clinic.
 
The positional responsibilities below are a general overview and may be modified in the future to fit the needs of the business.
 
DUTIES & RESPOSIBLILITIES:
Pain Clinic Job Responsibilities
  • Greet all patients and providers with a friendly smile
  • Register and schedule new patients
    • Verify insurance coverage (In Network or Out of Network)
    • Obtain Authorizations
      • UCare
      • Workers Compensation Cases
      • Tricare/VA
      • Doctor Referrals
  • Answer phones
  • Answer patient questions regarding billing/payment
    • Explain that most UCare, MA, Work Comp, Auto, and Disability insurance don’t have out-of-pocket costs
    • Other health insurances might have a co-pay or co-insurance, and we won’t know the exact cost until the claim has been processed
    • We also have a cash-pay option
  • Schedule and coordinate appointments with all Pain Clinic providers and patients
    • Explain the “Authorization to Treat” form and our separate business practices
    • E-mail “New Patient” paperwork
  • Call next day patients to confirm appointments, and enter note in appointment
  • Check in patients and collect any necessary co-pays and balances at patients appointments
  • Scan paperwork into accounts and create a name for the Plan of Care
  • Keep track of referrals and Plans of Care
  • Coordinate PTs schedule for meetings, networking, marketing, grand rounds, and vacations
  • Confirm that the RevFlow schedule matches the Greenway schedule
  • Call and schedule any Pain Clinic patients who have a waiting Physical Therapy order in Greenway
  • Perform networking and marketing duties to promote clinic growth in the community, including social media
Administration and Insurance-Related Job Responsibilities
  • Charges
    • Check for authorizations
      • UCare
      • Workers Compensation Cases
      • BCBS 20 visit limit
      • Clear Claim Delays
      • Correspond with PTs and CSRs
    • Check Medica for 4 units when Re-evaluation CPT is used
    • Double check correct evaluation codes are being used
    • Visits charged vs. Visits arrived
      • Correspond with PTs and CSRs
  • Research Write-Offs and Denials
    • Correspond with PTs and CSRs for help with denials or write-offs
      • Denials for no authorization requests – CSRs
      • Denials for Auto insurance and Workers Compensation insurance for exhausted benefits or Independent Medical Exams – obtain and change to personal health insurance
      • Denials for uncovered CPT codes, lack of documentation for medical necessity
      • Denials for lack of MD referrals – CSRs
  • Fix Accounts
    • Incorrect Insurance Codes
      • Incorrect Insurance ID’s
      • Subscriber information, i.e., Spouse, Child, Date of Birth
    • Addresses
  • Collections
    • Check high balances - make notes in appointments to collect
    • Past Due Balances - call patients to collect or set up a payment plan
    • Settlements with attorneys for auto cases
    • Refer hardships to Amanda for authorizations
  • Help all CSRs with questions regarding insurance verification, authorization, limits
 
SKILLS:
  • To be a well-rounded communicator with excellent written and verbal communication skills
  • Team mindset with patients and clinic first
  • Quickly adapt to changing needs and objectives
  • Act as a self-starter, demonstrate a “can-do” attitude approach to assigned tasks
  • Have a positive attitude and a welcoming presence towards people, with the ability to take feedback constructively
  • Exhibits leadership qualities.
  • Effective organizational, time management and planning skills.
  • Works independently without encouragement.
  • Ability to demonstrate exceptional judgment with respect to patient status, safety, referral and well-being.
  • Good problem-solving skills to identify and prioritize issues in a responsive manner and implement and execute action plan on timely basis.
  • Health Promotion and Maintenance.
  • Creating a Safe, Effective Environment.
 
PHYSICAL REQUIREMENTS:
  • Ability to walk, bend, stand, and reach constantly during a work day/shift.
  • Visual acuity (near and distant) sufficient to maintain accurate records, recognize people, and understand written direction.
  • Ability to speak and hear sufficiently to understand and give directions.
  • Ability to push wheeled equipment throughout the facility.
  • Ability to lift up to 25 lbs: office equipment, supplies, paper, boxes, etc.
 
OTHER EXPECTATIONS and ATTITUDES:
  • To maintain a happy, professional, positive, and polite demeanour always
  • Attend and actively participate in weekly team meetings
  • Conduct yourself in a mature, courteous and caring manner
  • To be self-motivated and possess the ability to reach out for help when needed
  • Represent yourself and the company professionally and maintain a clean and professional appearance
  • All company and client information are to be held in the strictest of confidence and must remain within the company
  • Acts as a role model and a resource for peers.
  • Assists in marketing, networking, advertising, and other avenues of business growth
  • Performs other duties or special projects as assigned.
 
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