Customer Service Associate Incoming Call Center & My chart

Duke Clinical Research Institute; Durham (NC); On-site; USD 42,000 - 64,000; Full time

Job summary

Duke Health in Durham, NC seeks a Patient Revenue Management Organization specialist to respond to patient billing inquiries, resolve statements, and explain benefits. You will review EOBs, eligibility, and payor information, while documenting actions and collaborating with internal teams.

The role requires strong analytical and communication skills, experience in healthcare billing, and the ability to manage multiple tasks with accuracy and empathy.

Qualifications

• Minimum of three years direct customer service or call center operations experience.
• Healthcare background in medical billing, collections, insurance claims processing, or related fields highly preferred.
• Inbound to outbound call center experience preferred.
• Working knowledge of Maestro Care system preferred.

Responsibilities

• Answer and resolve inbound inquiries regarding patient account statements, bad debt write-offs, explanations of benefits, balance due and other billing scenarios.
• Analyze patient issues by collecting information, researching in IDX, Hyland Onbase, Passport or BlueE for eligibility and payor details.
• Document PCS notes and communicate with patients, physicians, departments and external parties in a professional manner.
• Provide financial counseling and establish payment plans for patients requiring extended terms.
• Produce and mail itemized statements and assist with charity care screening when requested.

Skills

Analytical and problem-solving

Organizational skills

MS Word

MS Excel

Communication skills

Bilingual preferred

Teamwork

Education

High school diploma or equivalent

Two-year college degree preferred

Tools

Maestro Care

MS Word

MS Excel

Job description

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

Patient Revenue Management Organization

Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing and other essential revenue functions for Duke Health.

Occ Summary

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.

Work Performed

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 BlueE 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 PCS workfiles, the customer service follow up database and paper workfiles. Thoroughly update and document PCS notes or system comment fields with all information pertaining 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 request medical review and audit when necessary. Discuss and establish payment plans for patients that require extended terms to pay off a balance. Produce itemized statements. Mail and 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, transferringcredits, coding changes, service and charge disputes and locate payments. Following appropriate policy, update all system information to accessible fields to include correct registration information, address, telephone numbers, guarantor information, employer information, 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

Level Characteristics

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 teamworkskills 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

Minimum Qualifications

Education

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

Experience

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

N/A

Duke is an 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 (including pregnancy and pregnancy related conditions), sexual orientation or military 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 essential job 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.