Customer Service Representative I

massgeneralbrigham; United States; On-site; USD 45,000 - 65,000; Full time

Job summary

Mass General Brigham Incorporated seeks team members for Patient Billing Solutions to review and resolve guarantor balances. Roles include handling inbound/outbound contacts by phone, email, or secure Epic in-basket requests, with a focus on timely responses to guarantor inquiries.

Responsibilities include securing payments, processing adjustments, reviewing insurance processing, refunding balances, and updating demographic/insurance data across systems while maintaining HIPAA privacy standards.

Qualifications

• Epic experience, HB Resolute and PB Resolute knowledge
• HIPAA privacy compliance
• Customer service excellence and clear communication

Responsibilities

• Respond to guarantor inquiries via phone, email, or written correspondence.
• Resolve account balances by securing payments, making adjustments, or initiating reviews.
• Verify and update demographic and insurance information across billing systems.
• Obtain information from internal and payer sources to resolve patient inquiries.
• Document all interactions with a clear audit trail in the billing system.
• Maintain courteous, high-quality service to callers and escalate when needed.

Job description

Site: Mass General Brigham Incorporated

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

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 MGB
• Credit & 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