Customer Service Associate - Incoming Call Center Mychart

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.

 

About Duke Health's Patient Revenue Management Organization

 

Pursue your passion for caring with the Patient Revenue Management Organization, which is Duke Health's 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.

General Description of the Job Class
Answer and respond to all PRMO-related customer issues that are received by way of telephone and/or writing, meeting customer and departmental goals and objectives.

 Duties and Responsibilities of this Level

 

Call Inquiries 80%

Answer and resolve all inbound inquiries and issues regarding patient account statements, bad debt write-offs, 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 EPIC patient accounting systems, Hyland Onbase for documents that may have been imaged (EOBs, statements, admitting documentation, patient correspondence, etc.), RTE or BlueE for eligibility, researching payor websites and/or contacting the payor as 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.  Document issues/ requests using the Customer Relation Manager (CRM), the customer service follow-up database.

Thoroughly update and document 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 EOBs and payment details 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 terms to pay off a balance.

General 10%

Produce itemized statements and mail them to patients when requested.

Assist patients who are requesting charity care by completing a CRM with the necessary information to determine financial assistance status.  Provide feedback regarding the status of the application when requested by a patient.

Obtain and post credit card payments for accounts within departmental guidelines.  Follow department policy necessary for charge corrections, transferring credits, coding changes, service and charge disputes, and locating payments.  

Following the appropriate policy, update all system information to accessible fields to include correct registration information, address, telephone numbers, guarantor information, employer information, insurance information, etc. 

Other 5%

Identify trends in system problems, training, or procedural concerns.  Make recommendations and provide feedback regarding preventive action to the supervisor or manager.  

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 call volume or staffing needs.

5%

Perform other related duties incidental to the work described herein.

 
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Degrees, Licensure, 
and/or Certification:    N/A<