Customer Service Representative-(3287510) - Partners Healthcare System

Reporting to and working under the general direction of the Manager, the Customer Service Representative resolves guarantor/patient account balances. The Patient Business Office’s primary focus includes both timely responses to guarantor/patient inquiries via a variety of paths and outreach efforts to resolve open guarantor accounts. Contacts may be from initiated by patients via incoming call center, fax, mail, email, work listing or other vehicles of account resolution. The call center is the primary point for all inbound contacts from our patients. The representative utilizes multiple electronic billing and medical retrieval systems as well as knowledge of medical billing to resolve guarantor/patient inquiries. The representative must be able to respond knowledgeably to a wide range of patient issues for every contracted and non-contracted payer, including government and non-government payers, to resolve account balances. Our goal is to resolve all of the patient’s concerns while maintaining positive relationships with the guarantor/patient by providing the best possible service to all our customers thereby enhancing the overall engagement with the patient.

• Respond to patient/guarantor 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 and fiscal registrations in order to verify the patient’s responsibility for all outstanding balances. Verification process routinely includes contacting other departments at Partners/RCO/entities, payers, affiliated physician organizations and other vendors (Collection Agencies and other outsource agents). Representative must be fully versed in PHS Credit & Collection Policy and Financial Assistance Policy and must inform patients of all assistance available to them in when making payment arrangements, processing payments, initiating Financial Assistance application, or referring patients to Financial Counseling.
• Provide timely, professional, and accurate account review, analysis, and resolution of patient inquiries. Whenever possible, resolve issues during the initial telephone call. 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 including the completion of required supplemental information such as race/sex information 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 a variety of systems including hospital legacy billing systems (EPIC – HB and PB/BICS/PATCOM/Soarian/Invision), TRAC, QUIC, physician organization billing systems (IDX), document imaging (Sovera), eligibility verification systems (NEHEN, payer web sites) and other document backup (Document Direct) in order to analyze claims, resolve issues and respond to the patient’s inquiry. Obtain information from internal third-party payer units, patient PCP/Practice/Group Practice Management, payers, patient employer group, ambulance companies and other hospitals to help resolve the patient’s inquiry.
• Provide cordial, courteous and high quality service to callers. 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 correspondence, telephone and email, 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.
• Ensure accurate patient billing 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.
• Identify root cause(s) of guarantor/patient inquiries and report findings to management for appropriate resolution to future accounts. Follow up on individual issues to assure they are completed. Record and classify all communications in the appropriate systems for statistical reporting.
• Submit patient credit balances that need to be refunded to the appropriate parties for action by verifying the reason for the credit.
• 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.
• Follows through on commitments and achieves desired results. Exhibits sound judgment, obtains the facts, examines options, gains support, and achieves positive outcomes.
• Maintain high standards of professional conduct. Comply with the all applicable PHS Patient Billing Office policies and procedures. Follow department attendance expectations and arrive for work well prepared at expected time. Attend required training.
• Specific expectations and accountabilities include:
o Consistently answer calls at the average of the daily rate for the team, typically at least 70-80 calls per day.
o To the degree possible, maintain a daily list of all accounts accessed. Provide supervisor/manager with an account listing of all unresolved issues weekly.
o Manager/resolve at least 80% of patient issues without referring the call to the supervisor/manager.
o Pass routine quality assurance reviews at an average of >90%
• Performs other duties tasks or projects as assigned.

• High School diploma or GED equivalent required
• Associates Degree preferred but not required
• 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.

• Must have satisfactorily completed the CS Developmental Road Map (includes unit knowledge, systems, technical and interpersonal skills and Policy compliance
• 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 +20 hours with 6 – 8 weeks of peer to peer training is typical.
• 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
• Ability to manage multiple tasks/projects simultaneously
• Detail oriented

MGB Assembly Row

399 Revolution Drive

Somerville02145