New job Customer Service Representative in Massachusetts

Reporting to and working under the general direction of a Senior Manager or Manager, Customer Service staff in Patient Billing Solutions (PBS) primarily respond to inbound contacts from guarantors or their representatives to review their accounts and resolve any concerns raised by the guarantor. While the majority of contacts are by phone, there are also written correspondence, email or secure Epic in-basket messages. Primary focus includes timely responses to guarantor inquiries generally matching the method that was used to contact PBS. Account resolution takes many forms including securing payments, updating account information, making appropriate adjustments, initiating refunds, or initiating reviews by other teams in Revenue Cycle Operations including the professional billing teams. Account information updates include demographic and financial information. Activities include follow up on accounts that were previously highlighted for review to ensure that the review has been completed and actions have been completed to close the issue including contacting the guarantor if indicated. All Customer Service staff have some responsibility to answer phone calls via an Automated Call Distribution (ACD) system. Staff must be well versed in multiple Epic modules including HB Resolute, PB Resolute, Registration/ADT, Financial Assistance, CRM and Credit Specialist training. Broad based knowledge of medical billing and insurance processing is also required. Staff must be able to respond knowledgeably to a wide range of issues for every contracted and non-contracted payer, including government and non-government payers presenting their findings professionally in language that the guarantor can understand. Staff must be diligent in following HIPAA Privacy guidelines. The primary goal of PBS is to resolve the guarantor’s concerns focusing on providing excellent customer service that enhances the guarantor’s overall experience with Partners.

• Respond to patient/guarantor/customer concerns which span a wide range of issues including payer denials, coding accuracy/appropriateness, secondary billing, Coordination of Benefits, verification of co-payments/co-insurance/deductibles and verification/updates to demographic/insurance information and fiscal registrations to verify the patient’s responsibility for all outstanding balances. Verification process routinely includes contacting other Revenue Cycle departments at Partners (CBO teams, PBO teams) generally through the use of Account Work Queues. Other outreach to entities, payers and affiliated physician organizations will sometimes occur. Representatives must be fully versed in PHS Credit & Collection Policy and Financial Assistance Policy and able to inform patients of all assistance available to them when making payment arrangements, processing payments, Financial Assistance applications, or referring patients to Financial Counseling. All actions must be documented in Epic including Epic Customer Relations Module (CRM) to track the reason for the contact and update the account with clear concise notes.
• Respond to inquiries regarding requests for Financial Assistance by reviewing the patient’s status in the Financial Assistance module or opening a new case in the module when procedures indicate that is appropriate. Conduct simplified screening for financial assistance as applicable.

• Begin each patient contact by creating a ‘CRM’ folder to classify the reason for the contact. Seek to identify root cause(s) of guarantor/patient inquiries and document them as part of the CRM process. Follow up on individual issues CRM’s to assure they are completed. Flag unusual items or trends and alert the supervisor or manager if there are sensitive issues.

• Provide timely, professional, and accurate account review, analysis, and resolution of patient inquiries through review of account history, third party billing activity and analysis of payments and adjustments. Seek expert assistance from other departments such as Coding, Third Party Billing/Follow Up, Revenue Control/Cash Processing, and Group Practice Billing Managers by making appropriate inquiries through established channels, generally using Account Activities.

• Whenever possible, resolve issues during the initial patient contact. Verify the patient’s fiscal and demographic information at every opportunity and make appropriate updates to various billing systems to ensure claims are processed appropriately and Medicare as a Secondary Payer questionnaire. Resolve complex issues with minimal external or supervisory involvement. Document all patient interactions and account actions in assigned billing systems to establish a clear audit trail.
• Obtain information from and perform actions on accounts in Epic (HB and PB Resolute) and for selected HB accounts in QUIC. Look up information in other support systems as needed including, but not limited to, SharePoint, Legacy Data Access LDA, document imaging (OnBase), eligibility verification systems (Trizetto/Cognizant or payer web sites) and other document backup (SharePoint) to identify root cause issues. Use systems and information to resolve issues and respond to the patient’s inquiry. Obtain information from internal third-party payer units, intermediaries for professional practices and hospital departments, payers, ambulance companies and other hospitals/Home Health/Rehab Facilities to help resolve the patient’s inquiry.
• Use department SharePoint tool as needed to initiate a Privacy Incident or an Estimate Request.
• Understand liability claims, legal basics, medical terminology, a general knowledge of the PHS network hospitals including major variations in administrative protocols as well as key industry issues.

• Must provide cordial, courteous and high-quality service to callers. Must listens attentively to patients by placing customer concerns ahead of oneself. Understand and practice concern for patients as the ultimate consumers of service.
• Effectively handle all communications, which may include via Work Queues, correspondence, telephone and emails (PHS emails and Patient Gateway/Epic Inbox messages, from patients and other departments within PHS. Utilize customer service, collections, and billing experience to gather and interpret relevant information to resolve patient account issues and complaints.
• Representative must follow through on commitments, achieve desired results by exhibiting sound judgment, obtaining the facts, examine options, and engage with the guarantor to achieve positive outcomes.

• Respond to guarantor inquiries regarding open self-pay credits and flag them for appropriate attention either through a refund to the guarantor or to resolve credits that are not due to overpayments. Refund requests must be properly classified to ensure that the refund is executed.
• Communicate clearly and concisely both orally and in writing. Follow established regulations and procedures in collection, recording, storage and handling of information. Ensure required documentation of issues is complete, accurate, timely and legible. Protect and preserve confidentiality and integrity of all information according to PHS HIPAA confidentiality policy.
• Supports and demonstrates the values of the PHS and affiliates by conducting activities in an ethical manner with integrity, honesty, and confidentiality. Demonstrates a positive, open-minded, can-do attitude. Represents a team perspective and willingness and enthusiasm to collaborate with others. Enthusiastically promote a cooperative team environment to provide value to all customers. Listen and interact tactfully, diplomatically and effectively without alienating others.
• Maintain high standards of professional conduct. Comply with the all applicable PHS Patient Billing Solution policies and procedures. Follow department attendance expectations and arrive for work well prepared at expected time. Attend required training.
• Specific expectations and accountabilities include:
  • Consistently answer calls at the within +/-10% of the average of the rate for the team over a monthly period which generally averages 40-50 calls per day.
  • Resolves at least 80% of patient issues without referring the call to the supervisor or manager.
  • Pass routine quality assurance reviews at an average of >90%

• Performs other duties tasks or projects as assigned. Able to work and think independently while being self-motivated.
  

• High School diploma or GED equivalent required, Associates Degree or higher preferred
• Epic billing systems knowledge preferred

• Effective communication, organizational and problem-solving skills required.
• 1-3 years relevant experience in customer service or collections in a health care setting strongly desired.
• Alternative work experience or training in lieu of experience may be considered.
  

• Familiarity with medical/hospital billing systems and third-party payment processes desired. Must be very familiar with Epic HB, PB and SBO functions either due to prior training or through a combination of training classes and peer-to-peer training. Formal training of 30 plus hours with 6 – 8 weeks of peer to peer training is typical.
• Must have satisfactorily completed the CS Developmental Road Map (includes unit knowledge, systems, technical and interpersonal skills and Policy compliance.
• Knowledge of Word, Excel, and Outlook sufficient to perform all routine tasks including email, document preparation and worksheet preparation.
• Knowledgeable on basic Medicare issues including Medicare as a Secondary Payer (MSP).
• HIPAA Privacy guidelines
• Good verbal and written business communications skills sufficient to clearly document issues and communicate with patients.

• Effective organizational and problem-solving skills
• Be able to identify potential issues/patterns and escalate to management
• Ability to manage multiple tasks/projects simultaneously
• Detail oriented