CUSTOMER SERVICE ASSOCIATE - Call Center
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 PrimaryCare. 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.
CUSTOMER SERVICE ASSOCIATE
Answer and respond to all PRMO-related customer issues that are received by way of telephone, in person and/or writing, meeting customer and departmental goals and objectives.
- Answer and resolve all inbound inquiries and issues regarding patient account statements, bad debt write off's,
- Explanation of benefits, balance due, and other patient and insurance billing related scenarios.
- Analyze the patient's problem or issue that is presented by collecting information and data and conducting thorough research of the IDX patient accounting systems, Hyland Onbase for documents that may have been imaged (EOBs, statements, admitting documentation, patient correspondence, etc.), Passport or Blue E for eligibility, researching payor websites and/or contacting the payor is needed.
- Analyze information for an appropriate solution and take the necessary action needed to resolve the issue.
- Follow through on all customer issues promptly and accurately until completion.
- Open work items include issues that are tracked via PCSworkfiles, the customer service follow up database and paper workfiles.
- Thoroughly update and document PCS notes or system comment fields with all information per training to an inquiry (i.e. questions, answers, actions, follow up items required).
- Communicate with the patient, physicians, collection agency, internal departments and all other internal and external customers in a professional, courteous, and respectful manner.
- Post customer service adjustments when supported by policy, contractual adjustments and other adjustments as deemed necessary following appropriate write off guidelines.
- Update insurance information and file and/or appeal claims with insurance companies according to department guidelines.
- Take appropriate actions to bill insurance companies or patients with corrected information including accepting and inputting secondary insurance information into the system and filing claims.
- Coordinate patient refund requests with the credit balance department.
- Research EOB?s and payment detail to determine if a patient refund is necessary or determine the nature of the credit balance.
- Provide financial counseling to patients, guarantors, and attorneys regarding charges for health care services.
- Validate that charges are correct and re quest medical review and audit when necessary.
- Discuss and establish payment plans for patients that require extended terms to pay off a balance.
- Produce and mail itemized statements.
- Provide itemized statements to patients when requested.
- Assist patients that are requesting charity care by conducting an initial screening and sending or providing that patient a copy of the charity care application when requested.
- Provide feedback regarding status of the application when requested from a patient.
- Obtain and post credit card payments for accounts including authorized settlements within departmental guidelines.
- Follow department policy necessary for charge corrections, transferring credits, coding changes, service and charge disputes, and locate payments.
- Following appropriate policy, update all system information to accessible 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 feedback regarding corrective and preventive action to the supervisor or manager.
- Track the problem to ensure the inquiry is completed through PSC work files or the follow up database.
- Adhere to all HIPAA and confidentiality guidelines.
- Work with a diverse group of internal and external customers (i.e. attorneys, insurance companies, state agencies, physician offices, collection agencies, etc).
- Work as a team member towards common goals. Prepare and /or assist with special reports as requested by management.
- Adhere to a schedule to ensure customer availability and demonstrate flexibility to schedules according to patient or call volume or staffing needs.
- Perform other related duties incidental to the work described herein.
Knowledge, Skills and Abilities
- Analytical and problem-solving skills
- Strong organizational skills with the ability to multi-task and follow through on outstanding issues
- Strong computer skills with knowledge of MS Word, MS Excel and e-mail.
- Excellent interpersonal skills with the ability to communicate effectively both orally and in writing.
- Ability to work well with others - strong teamwork skills
- Must be flexible and able to function in a work environment where work and schedules may change to meet the needs of the patient.
- Demonstrated ability to work well with customers and deliver excellent customer service
- Ability to control and manage a phone call
- Bi-lingual preferred
- Knowledge 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 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 preferred. 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.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
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.