A call center job in healthcare services consists of three types of support tasks. Most outsourcing companies are known to hire small to large teams of agents to handle jobs in revenue cycle and medical billing management, medical data entry, and medical insurance claims.
Revenue Cycle and Medical Billing Management
The specific steps may differ depending on the clients' needs, but most of the tasks in revenue and billing management include the following:
a. Patient Pre-registration Process
The pre-registration process can be arduous and confusing for many patients. To make the process easier for them and their family, and to unburden the medical staff and let them do the job that they were trained for, many hospitals and clinics opt to outsource the work to young professionals who are trained to be patient and sensitive to the needs of their patients.
b. Appointment Scheduling
Something as simple as scheduling patients with their physicians can be assigned to agents rather than further put a burden on healthcare service providers. Patients can either call, text or email to set an appointment. Pharmaceutical reps can also do the same, but with a more streamlined process, the physician may choose to prioritize urgent cases over sales visits anytime.
c. Medical Billing
Assigning the medical billing process to call center agents can help alleviate the burden for both healthcare providers and insurance companies. There are certainly rules to follow and standards to meet, but the process doesn't take long to complete.
d. A/R Collections for Medical or Dental Practices
Collecting the money owed to one's medical or dental practice for services already rendered AND billed can be troublesome for many healthcare providers. Leaving them uncollected can lead to cash flow problems in the future. Outsourcing the job to a small team can alleviate the stress of losing a significant portion of one's income.
e. Patient Follow-ups
Being proactive with patient follow-ups is key to making sure the patient continues to receive excellent services from one's clinic or healthcare organization. Healthcare providers can monitor their patient's health, verify that the patient is receiving the right medication and dosage, and share lab results as soon as possible. Call center agents can do the job as well as a doctor's secretary.
Generating reports, which involves writing up a detailed description of the patient's symptoms and the succeeding diagnosis from the physician, can be considered outsource-able. It's part of a physician's secretary's tasks, but the amount of reports to produce can't be completed by just one person. Because the job can be replicated at the same quality and efficiency by a trained team of agents, many clinics and healthcare organizations choose to outsource the work.
Most agents are assigned as back-office support staff who work behind-the-scenes for various insurance companies. An important part of their work is credentialing for physicians or providers. Part of the process involves reviewing doctors' qualifications and career history including their education, training, residency and licenses, as well as any specialty certificates for compliance.
Data Entry Work in Medical Records, Billing and Claims
Another arduous process to conquer among healthcare providers is data entry, which involves adding and updating patient records, billing information, and claims. It's not as routine or boring as some people think, but just the same, it can be outsourced to somebody who's capable and without an urgent medical matter to attend to.
Processing of Medical Insurance Claims
a. Charge Entry
Accuracy in the charge entry process is a crucial part of medical billing. Billing verification must undergo several check-throughs to ensure the information is recent and correct.
b. Health Claim Transmission
Most companies that provide healthcare services outsourcing function as digital clearinghouses for medical insurance claims. There are many types of claims, which include pharmacy, dental, out-patient, and in-patient facility claims. All of these may come from millions of healthcare professionals and thousands of carriers.
c. Payment Posting
Insurance payment posting doesn't have to be complicated for patients and providers. The process can be easily completed by call center agents who are trained in data entry work and doing outbound calls for verification.
d. Accounts Receivable Follow-ups
Relatively recent billings are easier to collect compared to languishing accounts receivables. This is why follow-ups are essential to any medical practice. But, completing these follow-ups can use up an employee's valuable time away from serving the needs of patients. That's why outsourcing the job can help doctors, nurses and other healthcare professionals focus on what really matters most -- helping people get better from an illness.
e. Denial Management
A/R collection can often lead to denials in insurance claims. So, what can a medical practitioner do? Entrust the job to a team of agents who have been trained and certainly are more capable in weeding out the bad accounts from the good, and in hastening the routing of denials through the next steps in the workflow.
Outsourcing companies are bound to keep medical information confidential because of the contracts they entered into with their clients. Each agent has been thoroughly vetted for and has undergone compliance training before they can start with the job. Floor managers are at hand to provide guidance as well as supervise the agents' work.