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POST DATE 8/10/2016
END DATE 10/8/2016
JOB DESCRIPTIONABOUT US
As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Womens Hospital and Massachusetts General Hospital, Partners HealthCare supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
Were focused on a people-first culture for our systems patients and our professional family. Thats why we provide our employees with more ways to achieve their potential. Partners HealthCare is committed to aligning our employees personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal developmentand we recognize success at every step.
Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk, and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
Reporting to and working under the general direction of the Manager, the Collections Representative resolves guarantor/patient account balances. The Patient Billing Offices primary focus includes both timely responses to guarantor/patient inquiries via a variety of paths and outreach efforts to resolve open guarantor accounts. Contacts to the guarantor may be via an outgoing call, dialer system or based on an account work list. The representative utilizes multiple electronic billing and medical retrieval systems as well as knowledge of medical billing to resolve guarantor/patient inquiries. The representative must be able to respond knowledgeably to a wide range of patient issues for every contracted and non-contracted payer, including government and non-government payers, to resolve account balances. Our goal is to resolve all of the patients concerns and maximize guarantor collections while maintaining positive relationships with the guarantor/patient by providing the best possible service to all our customers thereby enhancing the overall engagement with the patient.
PRINCIPAL DUTIES AND RESPONSIBILITIES
o Contact the guarantor for accounts that are selected for follow up to try and resolve the guarantor balance either through collections or by initiating other appropriate follow up steps. Respond to patient/guarantor 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 and fiscal registrations in order to verify the patients responsibility for all outstanding balances. Verification process routinely includes contacting other departments at Partners/RCO/entities, payers, affiliated physician organizations and other vendors (Collection Agencies and other outsource agents). Representative must be fully versed in PHS Credit & Collection Policy and Financial Assistance Policy and must inform patients of all assistance available to them in when making payment arrangements, processing payments, initiating Financial Assistance application, or referring patients to Financial Counseling.
o Provide timely, professional, and accurate account review, analysis, and resolution of patient inquiries. Whenever possible, resolve issues during the initial telephone call. Verify the patients fiscal and demographic information at every opportunity and make appropriate updates to various billing systems to ensure claims are processed appropriately including the completion of required supplemental information such as race/sex information 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.
o Obtain information from and perform actions on a variety of systems including hospital legacy billing systems (EPIC HB and PB/BICS/PATCOM/Soarian/Invision), TRAC, QUIC, physician organization billing systems (IDX), document imaging (Sovera), eligibility verification systems (NEHEN, payer web sites) and other document backup (Document Direct) in order to analyze claims, resolve issues and respond to the patients inquiry. Obtain information from internal third-party payer units, patient PCP/Practice/Group Practice Management, payers, patient employer group, ambulance companies and other hospitals to help resolve the patients inquiry.
o Provides cordial, courteous and high quality service to callers. Listens attentively to patients by placing customer concerns ahead of oneself. Understand and practice concern for patients as the ultimate consumers of service.
o Effectively handle all communications, which may include correspondence, telephone and email, from patients and other departments within PHS. Utilize customer service, collections, and billing experience to gather and interpret relevant information to resolve patient account issues and complaints.
o Ensure accurate patient billing through review of account history, third party billing activity and analysis of payments and adjustments. Seek expert assistance from other departments such as Coding, Third Party Billing/Follow Up, Revenue Control/Cash Processing, and Group Practice Billing Managers by making appropriate inquiries through established channels.
o Identify root cause(s) of guarantor/patient inquiries and report findings to management for appropriate resolution to future accounts. Follow up on individual issues to assure they are completed. Record and classify all communications in the appropriate systems for statistical reporting.
o Submit patient credit balances that need to be refunded to the appropriate parties for action by verifying the reason for the credit.
o Communicate clearly and concisely both orally and in writing. Follow established regulations and procedures in collection, recording, storage and handling of information. Ensure required documentation of issues is complete, accurate, timely and legible. Protect and preserve confidentiality and integrity of all information according to PHS HIPAA confidentiality policy.
o Supports and demonstrates the values of the PHS and affiliates by conducting activities in an ethical manner with integrity, honesty, and confidentiality. Demonstrates a positive, open-minded, can-do attitude. Represents a team perspective and willingness and enthusiasm to collaborate with others. Enthusiastically promote a cooperative team environment to provide value to all customers. Listen and interact tactfully, diplomatically and effectively without alienating others.
o Follows through on commitments and achieves desired results. Exhibits sound judgment, obtains the facts, examines options, gains support, and achieves positive outcomes.
o Maintain high standards of professional conduct. Comply with the Collections and hospital policies and procedures. Follow department attendance expectations and arrive for work well prepared at expected time. Attend required training.
o Specific Duties
o Primary accountability is to engage the guarantor via outbound calls and/or correspondence. Will also respond to inbound calls and other correspondence that are directed to Collections.
o Review an average of 5 MRN/hour for every hour logged into the TRAC work flow system. Expected to maintain 100%