Customer Service Representative Patient Billing Solutions

Mass General Brigham (Enterprise Services); Somerville (MA); Remote; USD 35,000 - 45,000; Full time

Job summary

A healthcare organization is seeking Remote Customer Service Representatives to handle patient inquiries, resolve billing issues, and maintain HIPAA compliance. Candidates should have strong communication and problem-solving skills, with a preference for those experienced in healthcare. This full-time role offers a structured working model, operating Monday through Friday from 8:00 AM to 4:30 PM EST.

Qualifications

• 1-3 years of relevant experience in customer service or collections in a healthcare setting strongly preferred.
• Effective communication, organizational and problem-solving skills required.
• Epic billing systems knowledge preferred.

Responsibilities

• Respond to patient/guarantor concerns spanning wide range of issues.
• Provide timely account review, analysis, and resolution for patient inquiries.
• Document all patient interactions and account actions to establish an audit trail.

Skills

Effective communication

Organizational skills

Problem-solving skills

Education

High School diploma or GED

Associate’s Degree

Tools

Epic billing systems

Job description

Overview

The Opportunity: The team is growing and hiring Remote Customer Service Representatives. The teammates in Patient Billing Solutions (PBS) review and resolve guarantor account balances. Contact with guarantors can be inbound or outbound via phone, written correspondence, email, or secure Epic in-basket requests. Primary focus includes timely responses to guarantor inquiries generally matching the method used to contact PBS. Account resolution includes securing payments, making 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 in a Work Queue designated for PBS action. Most staff may answer phone calls via an Automated Call Distribution (ACD) process. This responsibility varies based on team assignment. Staff must follow HIPAA Privacy guidelines and possess broad knowledge of medical billing and insurance processing.

The primary goal of PBS is to resolve the guarantor’s concerns while providing excellent customer service that enhances their overall experience with MGB.

What You'll Do

• Respond to patient/guarantor/Customer concerns spanning 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 processes routinely include contacting other departments at MGB/RCO/entities, payers, affiliated physician organizations and other vendors (Collection Agencies and other outsource agents).
• Inform patients of Credit & Collection Policy and Financial Assistance Policy and all available assistance when making payments, processing payments, applications, or referring patients to Financial Counseling.
• Provide timely, professional, and accurate account review, analysis, and resolution of patient inquiries. When possible, resolve issues during the initial call. Verify fiscal and demographic information and update billing systems to ensure proper claim processing; resolve complex issues with minimal external or supervisory involvement. Document all patient interactions and account actions 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 (e.g., Legacy Data Access LDA, OnBase, NEHEN, payer websites, Sharepoint).
• Understand liability claims, legal basics, medical terminology, and general knowledge of the MGB network hospitals and administrative protocols.
• Provide cordial, courteous, high-quality service to callers. Listen attentively to patient concerns and maintain a patient-focused approach.
• Handle communications via Work Queues, correspondence, telephone, and emails (MGB emails and Patient Gateway/Epic Inbox) from patients and other departments. Use CS, collections, and billing experience to gather and interpret information to resolve account issues.
• Follow through on commitments with sound judgment, gather facts, examine options, gain support, and achieve positive outcomes.
• Document appropriately and protect patient information according to HIPAA confidentiality policy.

What You'll Bring

• High School diploma or GED required
• Associate’s Degree preferred
• Epic billing systems knowledge preferred
• Effective communication, organizational and problem-solving skills required
• 1-3 years of relevant experience in customer service or collections in a healthcare setting strongly preferred
• Alternative work experience or training may be considered in lieu of experience

Skills and Duties For Success

• Specific expectations and accountabilities include: consistently answering calls at the daily rate for the team, typically at least 40-50 calls per day
• Maintain a daily list of accessed accounts and provide supervisors with a weekly unresolved-issues list
• 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 as assigned; able to work independently and be self-motivated
• Properly document every accessed account with clear, concise notes
• Ensure accurate patient billing through review of account history and third-party activity; seek expert assistance from Coding, Third Party Billing/Follow Up, Revenue Control/Cash Processing, and Group Practice Billing Managers via established channels
• Identify root causes of guarantor/patient inquiries and report findings to management for future resolution; follow up on issues to completion; record and classify all communications in appropriate systems
• Submit patient credit balances for refund to the appropriate parties after verifying the reason for the credit
• Communicate clearly in writing and verbally; follow regulations and procedures for collection, recording, storage, and handling of information; maintain confidentiality per HIPAA
• Support and demonstrate MGB values with integrity and collaboration; promote a cooperative team environment and interact tactfully and professionally
• Follow through on commitments and maintain high standards of professional conduct; comply with MGB PBS policies and attendance expectations; participate in required training

Working Model

• M-F, 8:00 AM - 4:30 PM EST hours required
• Quiet, secure, stable, compliant work station required for remote role
• Video interviews required if selected for interviews
• Teams Video access required during first weeks

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. Reasonable accommodations are provided to assist eligible applicants in the application or interview process, to perform essential job functions, and to enjoy benefits and privileges of employment.