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POST DATE 10/23/2019
END DATE 12/7/2019
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 for both Hospital and Professional Bills. The Collection Representative primary focus is to contact the Guarantor/responsible party regarding payment of the medical charges. This also 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, or collection letter/from the account work queues. The representative utilizes multiple electronic billing and medical retrieval systems as well as knowledge of medical billing to resolve guarantor/patient issues. 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. The goal is to resolve the patients concerns, while collecting on the Guarantor medical bills to bring to resolution 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 in the account work queue 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, 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).
o Representative must be fully versed in PHS Credit & Collection Policy and Financial Assistance Policy and must inform patients of all assistance available to them when making payment arrangements, processing payments, initiating Financial Assistance application, or referring patients to Financial Counseling. Follows 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 Provide professional, timely and accurate account review, analysis, and resolution of patient medical bills. 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. Record and classify all communications in the appropriate systems. May submit patient credit balances that need to be refunded to the appropriated parties for action. 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 system (EPIC HB and PB), document imaging (Sovera), eligibility verification systems (NEHEN, payer web sites) and 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 medical bill.
o Effectively handles various communications, which may include Billing Correspondence, telephone and email from patients and other departments within PHS. Provides cordial, courteous and high quality service to our patients. Listens attentively to patients to insure we have full understanding of the issues that we need to resolve. Understand and practice concern for patients as it relates to medical billing issue.
o Ensure accurate patient billing through review of account history, third party billing activity and analysis of payments and adjustments. Seek appropriate 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 Supports and demonstrates the values of PHS and affiliates by conducting work activities in an ethical manner with integrity, honesty, and confidentiality. Demonstrates a positive can-do attitude. Represents a team perspective and willingness and collaborate with others. Enthusiastically promote a cooperative team environment.
o Maintain high standards of professional conduct. Communicate clearly and concisely both orally and in writing. Exhibits sound judgment, obtains the facts, examines options, gains support, to achieve positive outcomes. Comply with the Collections and hospital policies and procedures. Follow department attendance Policy 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 to collect payment or resolve outstanding bill. Will also respond to inbound calls and other correspondence that are directed to the Collections Unit.
o Work an average of 5 Guarantor accounts (MRN)/per hour for every hour logged into the Epic (assigned work queue) system. Expected to maintain 100% productivity on a monthly average.
o Maintain an average score of 9 out of 10 for all quality assurance reviews that are typically performed on a monthly basis. To the degree possible, limit referrals to the manager/supervisor to less than 20% of the guarantor account.
Partners HealthCare is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. 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.