Reporting to and working under the general direction of a Manger or Senior Manager, Collections staff in Patient Billing Solutions (PBS) primarily initiate contact with guarantors seeking to resolve outstanding self-pay account balances. Contacts are generally by generated by phone, written correspondence, email or secure Epic in-basket requests. Staff also respond to in-bound patient contacts that are in response to an automated collection notice (auto-dialer or automated letter) in in response to other patient contact letters regarding payment plans, Coordination of Benefits or other issues preventing an insurance payment. Account resolution takes many forms including securing payments, updating account information, making appropriate adjustments, initiating refunds, or initiating reviews by other teams in Revenue Cycle Operations including the professional billing teams. Account information updates include demographic and financial information. Work is primarily driven by system-based work queues with 20% or more of the work responding to patient calls. Most staff will have some responsibility to answer phone calls via an Automated Call Distribution (ACD) process. Account resolution typically requires expertise in multiple modules in Epic, including HB Resolute, PB Resolute, Registration/ADT and Credit Specialist training. Broad based knowledge of medical billing and insurance processing is also required. Staff must be well versed in multiple Epic modules including HB Resolute, PB Resolute, Registration/ADT, Financial Assistance, CRM and Credit Specialist training. Broad based knowledge of medical billing and insurance processing is also required. Staff must be able to respond knowledgeably to a wide range of issues for every contracted and non-contracted payer, including government and non-government payers presenting their findings professionally in language that the guarantor can understand. Staff must be diligent in following HIPAA Privacy guidelines. The primary goal of PBS is to resolve the guarantor's concerns focusing on providing excellent customer service that enhances the guarantor's overall experience with Partners.
Contact the guarantor for accounts in assigned work queues with the goal of clearing the accounts in a timely manner. Initial contact is by phone which may require leaving a message that meets privacy and security guidelines. Respond to patient/guarantor/Customer concerns during any contact. These concerns may 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/insurance information. The overall goal is to validate the guarantor balance and ensure that the guarantor understands the reasons for the balance. Verification process often includes contacting other departments at Partners/RCO including the professional billing teams generally via Epic bases WQ processes.
Representative must be fully versed in MGB 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. Representative must follow guidelines to ensure MGB compliance with MA collections regulations including permissible and impermissible contacts with the guarantor. Ensure required documentation of issues is complete, accurate, timely and legible. Protect and preserve confidentiality and integrity of all information according to MGB HIPAA confidentiality policy
Maintain assigned guarantor payment plans to ensure that payments are made regularly and resolve issues with suspended or rejected payment methods attached to auto-pay payment plans. Follow up on assigned accounts which may require that the patient be contacted to update their payment plan including adding new accounts to the payment plan.
Begin designated guarantor contacts by creating a 'CRM' folder to classify the reason for the contact. Seek to identify root cause(s) of guarantor/patient inquiries and document them as part of the CRM process. Follow up on individual issues CRM's to assure they are completed. Flag unusual items or trends and alert the supervisor or manager if there are sensitive issues.
Access information from a range of supporting systems or information sources including, but not limited to, Legacy Data Access LDA, document imaging (OnBase), eligibility verification systems (NEHEN, payer web sites) and other document backup (SharePoint) to identify root cause issues. Use systems and information to resolve issues and respond to the patient's inquiry. Obtain information from internal third-party payer units, intermediaries for professional practices and hospital departments, payers, ambulance companies and other hospitals/Home Health/Rehab Facilities to help resolve the patient's inquiry.
Effectively handle various communications, which may include Billing Correspondence, telephone and email from patients and other departments within MGB. Provide 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.
Provide timely, professional, and accurate account review, analysis, and resolution of patient inquiries 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, generally using Account Activities.
Whenever possible, resolve issues during the initial patient contact. Verify the patient's fiscal and demographic information at every opportunity and make appropriate updates to various billing systems to ensure claims are processed appropriately 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.
Obtain information from and perform actions on accounts in Epic (HB and PB Resolute) and for selected HB accounts in QUIC. Look up information in other support systems as needed including, but not limited to, SharePoint, Legacy Data Access LDA, document imaging (OnBase), eligibility verification systems (Trizetto/Cognizant or payer web sites) and other document backup (SharePoint) to identify root cause issues. Use systems and information to resolve issues and respond to the patient's inquiry. Obtain information from internal third-party payer units, intermediaries for professional practices and hospital departments, payers, ambulance companies and other hospitals/Home Health/Rehab Facilities to help resolve the patient's inquiry.
Use department SharePoint tool as needed to initiate a Privacy Incident or an Estimate Request.
Understand liability claims, legal basics, medical terminology, a general knowledge of the MGB network hospitals including major variations in administrative protocols as well as key industry issues.
Must provide cordial, courteous and high-quality service to callers. Must listens attentively to patients by placing customer concerns ahead of oneself. Understand and practice concern for patients as the ultimate consumers of service.
Effectively handle all communications, which may include via Work Queues, correspondence, telephone and emails (MGB emails and Patient Gateway/Epic Inbox messages, from patients and other departments within MGB. Utilize customer service, collections, and billing experience to gather and interpret relevant information to resolve patient account issues and complaints.
Representative must follow through on commitments, achieve desired results by exhibiting sound judgment, obtaining the facts, examine options, and engage with the guarantor to achieve positive outcomes.
Respond to guarantor inquiries regarding open self-pay credits and flag them for appropriate attention either through a refund to the guarantor or to resolve credits that are not due to overpayments. Refund requests must be properly classified to ensure that the refund is executed.
Follow guidelines to correctly assess and apply payments for HSN Surcharges. Respond to guarantor questions regarding the nature of the surcharge.
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 MGB HIPAA confidentiality policy.
Supports and demonstrates the values of the MGB 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.
Supports and demonstrates the values of MGB 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.
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.
Primary engage the guarantor via outbound calls, answering calls coming in via the Automated Call Distribution system (ACD) (30% of time) 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.
Provide back up for Customer Service ACD calls during periods of low staffing/high demand in Customer Service.
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.
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.
Performs other duties tasks or projects as assigned.
High School diploma or GED equivalent required. Associates Degree preferred but not required
Epic billing systems knowledge preferred
Effective communication, organizational and problem-solving skills required.
1-3 years' relevant experience in customer service or collections in a health care setting strongly desired.
Alternative work experience or training in lieu of experience may be considered.
Must have satisfactorily completed the Patient Billing Solutions training department program (includes unit knowledge, systems, technical and interpersonal skills and Policy compliance
Familiarity with medical/hospital billing systems and third-party payment processes desired. This includes familiar with Epic HB, PB and SBO functions either due to prior training or through a combination of training classes and peer-to-peer training. Formal training of 20+ hours combined with 6 - 8 weeks of Unit Management team and peer training is typical.
Knowledge of Word, Excel, and Outlook sufficient to perform all routine tasks including email, document preparation and worksheet preparation.
Knowledgeable on basic Medicaid Process relating to resolving account and Medicare as a Secondary Payer (MSP).
HIPAA Privacy guidelines
Good verbal and written business communications skills sufficient to clearly document issues and communicate with patients.
Effective organizational and problem-solving skills
Ability to manage multiple tasks/projects simultaneously