Customer Service Associate - Incoming Call Center & My Chart

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 Duke’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.

Occ Summary

Answer and respond to all PRMO-related custome r i>ssues that are receivedby way of telephone, in person and/or writing , meeting customer anddepartmental goals and objectives.

Wor k Performed

Answer and resolve all inbound inquiries and issues r egarding patientaccount statements, bad debt write off's, explanation of benefits,balance due, and other patient and insurance billing related s cenarios.Analyze the patient's problem or issue that is presented by col lectinginformation and data and conducting thorough research of the IDX patientaccounting systems, Hyland Onbase for documents that may have bee nimaged (EOBs, statements, admitting documentation, patientcorrespondenc e,etc.), Passport or BlueE for eligibility, researchingpayor websites an d/or contacting the payor is needed. Analyzeinformation for an appropria tesolution and take the necessary actionneeded to resolve the issue.Foll owthrough on all customer issues promptly and accurately untilcompletion .Open work items include issues that are tracked via PCSworkfiles, the c ustomer service follow up database andpaper workfiles.Thoroughly updatea nd document PCS notes or system comment fields withall information perta ining to an inquiry (i.e.questions, answers,actions, follow up itemsrequ ired).Communicate with the patient, physicians, collection agency, inter naldepartments and all other internal and external customers in aprofess ional, courteous, and respectful manner.Post customer service adjustment swhen supported by policy, contractualadjustments and other adjustmentsa s deemed necessary followingappropriate write off guidelines.Update insu rance information and file and/or appeal claims withinsurance companiesa ccording to department guidelines. Take appropriateactions to bill insur ance companies or patients with correctedinformation including accepting and inputting secondary insuranceinformation into the system andfiling claims.Coordinate patient refund requests with the credit balance depart ment.Research EOB?s and payment detail to determine if a patientrefundis necessary or determine the nature of the credit balance.Provide financia l counseling to patients, guarantors, and attorneysregarding chargesfor health care services. Validate thatcharges arecorrect and request medic al review and audit when necessary.Discuss and establish payment plans f or patients that require extendedterms to pay off a balance.Produceitemi zed statements. Mail and provide itemized statements topatients when req uested.Assist patients that are requesting charity care by conducting an initial screening and sending or providing that patient a copy of thecha rity care application when requested. Provide feedback regardingstatus o f the application when requested from a patient.Obtain and post credit c ard payments for accounts including authorizedsettlements within departm ental guidelines. Follow department policynecessary for charge correctio ns, transferring credits, coding changes,service and chargedisputes, and locate payments.Following appropriate policy, update all system informa tion toaccessible fields to include correct registration information, ad dress,telephone numbers, guarantor information, employer information,ins urance information, etc.Identify trends in system problems,trainingor pr ocedural concerns.Make recommendations and provide feedback regarding co rrective andpreventive action to the supervisor or manager. Trackthe pro blem toensure the inquiry is completed through PSC workfiles or the foll ow updatabase.Adhere to all HIPAA and confidentiality guidelines.Work wi th a diverse group of internal and external customers (i.e.attorneys, in surance companies, state agencies, physician offices,collection agencies , etc).Workas a team membertowards common goals.Prepare and /orassist wi th special reports as requested by management.Adhereto a schedule to ens ure customer availabilityand demonstrateflexibility to schedules accordi ng to patient or call volume or staffingneeds.Perform other related duti es incidental to the work described herein.

Knowledge, Skill s and Abilities

Analytical and problem-solving skillsStrong organiza tional skills with the ability to multi-task and followthroughon outstan ding issuesStrong computer skills with knowledge of MS Word,MS Excel and e-mailExcellent interpersonal skills with the ability to communicateeff ectively both orally and in writingAbility towork well withothers - stro ng teamwork skillsMust be flexible and ableto function in awork environm ent where workand schedules may change tomeet the needs ofthe patientDem onstrated ability to work well with customers and deliverexcellentcustom er serviceAbility to control and manage a phone callBi-lingual preferred Knowledge of DUHS billing preferred

Minimum Qualifications

Education

Work requires knowledge of basic grammar and mathematical principles normally required through a high school education. Two-year college degree preferred.

Experience

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

N/A

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