Customer Service Representative I

Job Summary: Reporting to and working under the general direction of the Manager, the teammates in Patient Billing Solutions (PBS) review and resolve guarantor account balances. Contact with guarantors can be either inbound contacts or outbound contacts that are generated by phone, written correspondence, email or secure Epic in-basket requests. Primary focus includes timely responses to guarantor inquiries generally matching the method that was used to contact PBS. Account resolution takes many forms including securing payments, making appropriate adjustments, initiating reviews of insurance processing, refunding guarantor balances or resolving a wide range of registration, demographic or insurance coverage issues. Some guarantor accounts will be queued for action due to the account being placed in a Work Queue that is designated for action by a PBS team. Most staff will have some responsibility to answer phone calls via an Automated Call Distribution (ACD) process (i.e. Call Center). This responsibility will vary based on the specific team assignment. Account resolution typically requires expertise in multiple modules in Epic, including HB Resolute, PB Resolute, Registration/ADT and Credit Specialist training. Broad based knowledge of medical billing and insurance processing is also required. Staff must be able to respond knowledgeably to a wide range of issues for every contracted and non-contracted payer, including government and non-government payers presenting their findings professionally in language that the guarantor can understand. Staff must be diligent in following HIPAA Privacy guidelines. The primary goal of PBS is to resolve the guarantor’s concerns focusing on providing excellent customer service that enhances their overall experience with MGB.Respond to patient/guarantor/Customer 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/insurance information and fiscal registrations to verify the patient's responsibility for all outstanding balances. Verification process routinely includes contacting other departments at MGB/RCO/entities, payers, affiliated physician organizations and other vendors (Collection Agencies and other outsource agents). Representative must be fully versed in MGBCredit & Collection Policy and Financial Assistance Policy and must inform patients of all assistance available to them when making payment arrangements, processing payments, 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 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 accounts in Epic (HB and PB Resolute) and for selected HB accounts, TRAC and QUIC. Look up information in other support systems as needed including, but not limited to, Legacy Data Access LDA, document imaging (OnBase), eligibility verification systems (NEHEN, payer web sites) and other document backup (Sharepoint) to identify root cause issues. Use systems and information to resolve issues and respond to the patient's inquiry. Obtain information from internal third-party payer units, intermediaries for professional practices and hospital departments, payers, ambulance companies and other hospitals/Home Health/Rehab Facilities to help resolve the patient's inquiry. Understand liability claims, legal basics, medical terminology, a general knowledge of the MGB network hospitals including major variations in administrative protocols as well as key industry issues. Must provide cordial, courteous and high-quality service to callers. Must 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 via Work Queues, correspondence, telephone and emails (MGB emails and Patient Gateway/Epic Inbox messages, from patients and other departments within MGB. Utilize customer service, collections, and billing experience to gather and interpret relevant information to resolve patient account issues and complaints. Follow through on commitments and achieves desired results. Exhibits sound judgment, obtains the facts, examines options, gains support and achieves positive outcomes. Properly document every account that is accessed. Document with clear concise notes. 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 MGB HIPAA confidentiality policy. Supports and demonstrates the values of the MGB 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 MGB Patient Billing Solution policies and procedures. Follow department attendance expectations and arrive for work well prepared at the expected time. Attend required training. Specific expectations and accountabilities include: Consistently answer calls at the average of the daily rate for the team, typically at least 40-50 calls per day. To the degree possible, maintain a daily list of all accounts accessed. Provide supervisor/manager with an account listing of all unresolved issues weekly. Representative resolves at least 80% of patient issues without referring the call to the supervisor/manager. Pass routine quality assurance reviews at an average of >90%Performs other duties tasks or projects as assigned. Able to work and think independently while being self-motivated.

EEO Statement: 0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.