Customer Service Associate Incoming Call Center & My chart

Duke University Health System is committed to compassionate care and is seeking a Customer Service Associate for their Patient Revenue Management Organization. This role involves answering inbound inquiries regarding patient billing, resolving issues, and ensuring a high level of customer service in a remote environment.

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 EOB's 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:

• Analytical and problem-solving skills
• 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
• 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
• Bi-lingual
• Two-year college degree
• A minimum of three years direct customer service or call center preferred
• A 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