CUSTOMER SERVICE REPRESENTATIVE
Partners HealthCare - Charlestown, MA

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About Our Organization

Partners HealthCare is an integrated health care system founded by Brigham and Women's Hospital and Massachusetts General Hospital. In addition to its two academic medical centers, the Partners system includes community and specialty hospitals, community health centers, a physician network, home health and long-term care services, and other health-related entities. Partners is one of the nation's leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School. Partners HealthCare is a not-profit organization. We have opportunities in Finance, Information Systems, Human Resources, and many other areas that work behind the scenes in support of the Partners mission.

General Overview

Working under the general direction of a Manager, the Customer Service Representative resolves issues raised by patient inquiries via telephone, fax, mail and email. The representative must be able to respond knowledgeably to a wide range of patient issues for every contracted and non-contracted payer, in order to resolve patient account balances for BWH and MGH. Issues routinely managed include payer denials, questions on coding, secondary billing, Coordination of Benefits, verification of co-payments/co-insurance/deductibles and updating registration information (demographics and fiscal) in order to verify the patient’s responsibility for all outstanding balances. Verification process will routinely include contacting other departments at Partners/MGH/BWH, payers, affiliated physician organizations and other contractors (Collection Agencies and other outsource agents). Where possible, assist patients with making payment arrangements including offering appropriate discounts, negotiating payment plan arrangements and processing of credit card payments. The goal is to resolve all of the patient’s concerns, help maintain positive patient relations and resolve open balances.

Responsibilities

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Provide timely, professional, and accurate account review, analysis, and resolution of patient inquiries. Whenever possible, issues should be resolved during the initial telephone call. Verify the patient’s fiscal and demographic information at every opportunity making appropriate updates in the legacy billing systems and ensuring that all 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 the legacy billing systems to establish a clear audit trail.

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Identify the underlying cause(s) of each patient inquiry, including correctable issues, and report findings are requested. Review account coding and refer coding issues to other units for resolution. Follow up on individual issues to assure they are completed including contact with the patient’s insurer if necessary. Help in the identification of any trends or major issues. Record and classify all communications in the appropriate systems for statistical reporting.

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Obtain information from and perform actions on a variety of systems including hospital legacy billing systems (BICS/PATCOM), CT Vision, 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, payers, patient employer group, ambulance companies and other hospitals to help resolve the patient’s inquiry. Work with insurers as needed to secure payment of a claim by rebilling claims and/or submission of requested information.

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Carefully determine the resolutions needed on a claim to make the appropriate hand-off either internally or externally using knowledge of Third Party reimbursement, Medicare guidelines and pertinent self pay billing regulations.

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Assist in the identification credits that need to be refunded by reviewing claims and verifying the reason for the credit including resolution of Coordination of Benefits issues. Route third party refunds to the appropriate work group and initiate patient refunds as needed.

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Assist on special projects as deemed appropriate by manager / director including credit resolution, researching of missing payment, and supporting to Cash Application process by identifying the correct account for payment in a suspense process.

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Assist in the training of new staff through a one-on-one mentoring process including monitoring/coaching of new staff during live call resolutions with patients.

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Performs other duties tasks or projects as assigned.

Qualifications

Experience: A combination of at least 3 years medical billing and/or customer service experience is required. Education: Associates degree preferred but not required

Required Skills:
Skills/Abilities/Competencies

Knowledge of Word, Excel, and Outlook sufficient to perform all routine tasks including email, document preparation and worksheet preparation.Familiarity with medical/hospital billing systems and third party payment processesKnowledgeable on basic Medicare issues including Medicare as a Secondary Payer (MSP).Good verbal and written business communications skills sufficient to clearly document issues and communicate with patients.

EEO Statement

Partners HealthCare System is an Equal Opportunity Employer

Partners HealthCare System - 21 months ago - save job - block
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About this company
43 reviews
Partners HealthCare, located in Boston, is an integrated health system founded by Brigham and Women`s Hospital and Massachusetts General...