CUSTOMER SERVICE ASSOCIATE - INCOMING CALL CENTER & CORRESPONDENCE
Duke University Health System
Location: Durham, North Carolina
Internal Number: 190508
PRMO Established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke Primary Care. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Dukeâ€™s reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance.
Answer and respond to all PRMO-related customer i ssues that are receivedby way of telephone, in person and/or writing, me eting customer anddepartmental goals and objectives.
Work Pe rformed
Answer and resolve all inbound inquiries and issues regar ding patientaccount statements, bad debt write off's, explanation of ben efits,balance due, and other patient and insurance billing related scena rios.Analyze the patient's problem or issue that is presented by collect inginformation and data and conducting thorough research of the IDX pati entaccounting systems, Hyland Onbase for documents that may have beenima ged (EOBs, statements, admitting documentation, patientcorrespondence, e tc.), Passport or BlueE for eligibility, researchingpayor websites and/o r contacting the payor is needed. Analyzeinformation for an appropriate solution and take the necessary actionneeded to resolve the issue.Follow through on all customer issues promptly and accurately untilcompletion. Open work items include issues that are tracked via PCSworkfiles, the c ustomer service follow up databaseand paper workfiles.Thoroughly update and document PCS notes or system comment fields withall information per taining to an inquiry (i.e. questions, answers,actions, follow up items required).Communicate with the patient, physicians, collection agency, i nternaldepartments and all other internal and external customers in apro fessional, courteous, and respectful manner.Post customer service adjust ments when supported by policy, contractualadjustments and other adjustm ents as deemed necessary followingappropriate write off guidelines.Updat e insurance information and file and/or appeal claims withinsurance comp anies according to department guidelines. Take appropriateactions to bil l insurance companies or patients with correctedinformation including ac cepting and inputting secondary insuranceinformation into the system and filing claims.Coordinate patient refund requests with the credit balanc edepartment.Research EOB?s and payment detail to determine if a patient refund isnecessary or determine the nature of the credit balance.Provid e financial counseling to patients, guarantors, and attorneysregarding c harges for health care services. Validate that charges arecorrect and re quest medical review and audit when necessary.Discuss and establish paym ent plans for patients that require extendedterms to pay off a balance.P roduce itemized statements. Mail and provide itemized statements topatie nts when requested.Assist patients that are requesting charity care by c onducting aninitial screening and sending or providing that patient a co py of thecharity care application when requested. Provide feedback regar dingstatus of the application when requested from a patient.Obtain and p ost credit card payments for accounts including authorizedsettlements wi thindepartmentalguidelines. Follow department policynecessary for char ge corrections, transferring credits, coding changes,service and charge disputes, and locate payments.Following appropriate policy, update all s ystem information toaccessible fields to include correct registration in formation, address,telephone numbers, guarantor information, employer in formation,insurance information, etc.Identify trends in system problems, training or procedural concerns.Make recommendations and provide feedba ck regarding corrective andpreventive action to the supervisor or manage r. Track the problem toensure the inquiry is completed through PSC work files or the follow updatabase.Adhere to all HIPAA and confidentiality g uidelines.Work with a diverse group of internal and external customers ( i.e.attorneys, insurance companies, state agencies, physician offices,co llection agencies, etc).Work as a team member towards common goals.Prepa re and /or assist with special reports as requested by management.Adhere to a schedule to ensure customer availability and demonstrateflexibilit y to schedules according to patient or call volume or staffingneeds.Perf orm other related duties incidental to the work described herein.
Knowledge, Skills and Abilities
Analytical and problem-solv ing skillsStrong organizational skills with the ability to multi-task an d followthrough on outstanding issuesStrong computer skills with knowled ge of MS Word, MS Excel and e-mailExcellent interpersonal skills with th e ability to communicateeffectively both orally and in writingAbility to work well with others - strong teamwork skillsMust be flexible and able to function in a work environment where workand schedules may change to meet the needs of the patientDemonstrated ability to work well with cus tomers and deliver excellentcustomer serviceAbility to control and manag e a phone callBi-lingual preferredKnowledge of DUHS billing preferred
Work requires knowledge of basic grammar and mathematical principles normally required through a high school education. Two-year college degree preferred.
A minimum of three years direct customer service or call center preferred. operations experience is required. 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, is highly Inbound to outbound call center experience preferred. Working knowledge of Maestro Care system preferred.
Degrees, Licensures, Certifications
Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
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Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
As a world-class academic and health care system, Duke Health strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities.