Customer Service Associate - HBC Transplant

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.

 

Patient Revenue Management Organization

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

General Description - Work Hours 8-4:30am or 8am-5pm  NC Residents only 

Answer and respond to all PRMO-related transplant customer service issues that are  by way of telephone and/or writing, meeting customer and departmental goals and objectives.

Duties and Responsibilities of this Level
Answer and resolve all inbound inquiries and issues regarding patient account statements, bad debt write off’s, 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 Maestro Care  patient accounting systems, Hyland Onbase for documents that may have been imaged (EOBs, statements, admitting documentation, patient correspondence, etc.), 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. Ensure Transplant contract guidelines are followed for appropriate payments and adjustments.
Follow through on all customer issues promptly and accurately until completion. Open work items include issues that are tracked via the Transplant Team E-mail, CRM’s and or assigned  workques.
Thoroughly update and document Financial Comments in Maestro Care with all information pertaining to an inquiry (i.e. questions, answers, actions, follow up items required). Maintain spreadsheets on all patients.
Communicate with the patient, physicians, 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 Transplant Credit Balance Representatives and/or Credit Balance Department. Research EOBs and payment detail 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.
Refer patients to PRMO customer service representatives to establish payment plans for patients that require extended terms to pay off a balance.
Produce itemized statements and mail to patients when requested and/or refer to PRMO customer service representatives.
Identify trends in system problems, training or procedural concerns. Make recommendations and provide feedback regarding corrective and preventive action to the supervisor or manager. Stay abreast of all Transplant Contracts and updates.
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.
Perform other related duties incidental to the work described herein..

Required Qualifications at this Level
Education:    Work requires knowledge of basic grammar and mathematical principles normally required through a high school education. Two-year college degree preferred. 
 
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Experience:    A minimum of three years direct customer service or call center operations experience is required. A healthcare background working in medical billing, collections, insurance claims processing, coding, registration, working in a medical organization, or like experience in the fields of education, training, training development, is highly preferred. 
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