Duke Health is committed to compassionate care that impacts patients and their families positively. They are looking for a Customer Service Associate to join the Patient Revenue Management Organization, where the role involves resolving patient inquiries related to billing and insurance, and supporting healthcare operations.

Responsibilities:

Answer and resolve all inbound inquiries and issues regarding patient account statements, bad debt write off's, explanation of benefits, balance due, and other patient and insurance billing related scenarios
Analyze the patient's problem or issue that is presented by collecting information and data and conducting thorough research of the IDX patient accounting systems, Hyland OnBase for documents that may have been imaged (EOBs, statements, admitting documentation, patient correspondence, etc.), Passport or Blue E for eligibility, researching payor websites and/or contacting the payor is needed. Analyze information for an appropriate solution and take the necessary action needed to resolve the issues
Follow through on all customer issues promptly and accurately until completion. Open work items include issues that are tracked via PCS work files, the customer service follow up database and paper work files. Thoroughly update and document PCS notes or system comment fields with all information per training to an inquiry (i.e. questions, answers, actions, follow up items required)
Communicate with the patient, physicians, collection agency, internal departments and all other internal and external customers in a professional, courteous, and respectful manner
Post customer service adjustments when supported by policy, contractual adjustments and other adjustments as deemed necessary following appropriate write off guidelines. Update insurance information and file and/or appeal claims with insurance companies according to department guidelines
Take appropriate actions to bill insurance companies or patients with corrected information including accepting and inputting secondary insurance information into the system and filing claims. Coordinate patient refund requests with the credit balance department
Research EOBs and payment detail to determine if a patient refund is necessary or determine the nature of the credit balance. Provide financial counseling to patients, guarantors, and attorneys regarding charges for health care services
Validate that charges are correct and request medical review and audit when necessary. Discuss and establish payment plans for patients that require extended terms to pay off a balance
Produce itemized statements. Mail and provide itemized statements to patients when requested
Assist patients that are requesting charity care by conducting an initial screening and sending or providing that patient a copy of the charity care application when requested
Provide feedback regarding status of the application when requested from a patient
Obtain and post credit card payments for accounts including authorized settlements within departmental guidelines. Follow department policy necessary for charge corrections, transferring credits, coding changes service and charge disputes, and locate payments. Following appropriate policy, update all system information to accessible fields to include correct registration information, address, telephone numbers, guarantor information, employer information, insurance information, etc. Identify trends in system problems, training or procedural concerns
Make recommendations and provide feedback regarding corrective and preventive action to the supervisor or manager. Track the problem to ensure the inquiry is completed through PSC work files or the follow up database. Adhere to all HIPAA and confidentiality guidelines
Work with a diverse group of internal and external customers (i.e. attorneys, insurance companies, state agencies, physician offices, collection agencies, etc.). Work as a team member towards common goals. Prepare and/or assist with special reports as requested by management. Adhere to a schedule to ensure customer availability and demonstrate flexibility to schedules according to patient or call volume or staffing needs
Perform other related duties incidental to the work described herein

Requirements:

customer service
call center operations
medical billing
insurance claims processing
patient registration
ms word
ms excel
email communication
analytical skills
multitasking
problem resolution
bilingual communication
maestro care system
strong organizational skills with the ability to multi-task and follow through on outstanding issues
strong computer skills with knowledge of MS Word, MS Excel and e-mail
excellent interpersonal skills with the ability to communicate effectively both orally and in writing
ability to work well with others - strong teamwork skills
must be flexible and able to function in a work environment where work and schedules may change to meet the needs of the patient
demonstrated ability to work well with customers and deliver excellent customer service
ability to control and manage a phone call
work requires knowledge of basic grammar and mathematical principles normally required through a high school education
a minimum of three years direct customer service or call center operations experience is required
two-year college degree
a minimum of three years direct customer service or call center preferred
healthcare background working in medical billing, collections, insurance claims processing, coding, registration, working in a medical organization, or like experience in the fields of education, training, training development
inbound to outbound call center experience
working knowledge of Maestro Care system

Customer Service Coordinator

Key skills

About this role