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Customer Service Representative

Thrive Physical Therapy
Job Description
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.
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
  • 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.
  • 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.
  • 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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