CUSTOMER SERVICE ASSOCIATE – INCOMING CALL CENTER & CORRESPONDENCE

Durham, North Carolina, PRMO Established in 2001, Patient Revenue Management Organization (PRMO) is a fully integrated, centralized revenue cycle organization supporting all of Duke Health, including Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, the Private Diagnostic Clinic, and Duke Primary Care. The PRMO focuses on streamlining the revenue cycle through enhanced management of scheduling, registration, coding, HIM operations, billing, collections, cash management, and customer service. The Mission of the PRMO is delivering quality service by enhancing the patient experience, providing financial security, and preserving Duke’s reputation and mission of advancing health together. Our Vision is to be recognized as a world class innovative revenue cycle organization that values our people, patients and performance. Occ Summary Answer and respond to all PRMO-related custome r issues that are receivedby way of telephone, in person and/or writing, meeting customer anddepartmental goals and objectives. Work Performed Answer and resolveall inbound inquiries and issues re garding patientaccount statements, bad debt write off’s, explanation of benefits,balance due, and other patient and insurance billing related sc enarios. Analyze the patient’s problem or issue that is presented by coll ectinginformation and data and conducting thorough research of the IDX p atientaccounting systems, Hyland Onbase for documents that may have been imaged (EOBs, statements, admitting documentation, patientcorrespondence , etc. ), Passport or BlueE for eligibility, researchingpayor websites an d/or contacting the payor is needed. Analyzeinformation for an appropria tesolution and take the necessary actionneeded to resolve the issue. Foll owthrough on all customer issues promptly and accurately untilcompletion.

Open work items include issues that are tracked via PCSworkfiles,the c ustomer service follow up database and paper workfiles. Thoroughly update and document PCS notes or system comment fields withall information pert aining to an inquiry (i. e. questions, answers,actions, follow up itemsre quired). Communicate with the patient, physicians, collection agency, int ernaldepartments and all other internal and external customers in aprofe ssional, courteous, and respectful manner. Post customer service adjustments when supported by policy, contractualadjustments and other adjustmen ts as deemed necessary followingappropriate write off guidelines. Update insurance information and file and/or appeal claims withinsurance compan ies according to department guidelines. Take appropriateactions to bill insurance companies or patients with correctedinformation including acce pting and inputting secondary insuranceinformation into the system andfi ling claims. Coordinate patient refund requests with the credit balance d epartment. Research EOB.

s and payment detail to determine if a patientref und isnecessary or determine the nature of the credit balance. Provide fi nancial counseling to patients, guarantors, and attorneysregarding charg es for health care services. Validate that charges arecorrect and reques t medical review and audit when necessary. Discuss and establish payment plans for patients that require extendedterms to pay off a balance. Produ ce itemized statements. Mail and provide itemized statements topatients when requested. Assist patients that are requesting charity care by condu cting aninitial screening and sending or providing that patient a copy o f thecharity care application when requested. Provide feedback regarding status of the application when requested from a patient. Obtain and post credit card payments for accounts including authorizedsettlements within departmental guidelines. Follow department policynecessary for charge c orrections, transferring credits, coding changes,service and chargedispu tes, and locate payments.

Following appropriate policy, update all system information toaccessible fields to include correct registration informa tion, address,telephone numbers, guarantor information, employer informa tion,insurance information, etc. Identify trends in system problems,train ing or procedural concerns. Make recommendations and provide feedback reg arding corrective andpreventive action to the supervisor or manager. Tra ck the problem toensure the inquiry is completed through PSC workfiles o r the follow updatabase. Adhere to all HIPAA and confidentiality guidelin es. Work with a diverse group of internal and external customers (i. e. att orneys, insurance companies, state agencies, physician offices,collectio n agencies, etc). Work as a team membertowards common goals. Prepare and /or assist with special reports as requested by management.

Adhereto a sc hedule to ensure customer availability and demonstrateflexibility to sch edules according to patient or call volume or staffingneeds. Perform othe r related duties incidental to the work described herein. Kn owledge, Skills and Abilities Analytical and problem-solving skil lsStrong organizational skills with the ability to multi-task and follow through on outstanding issuesStrong computer skills with knowledge of MS Word, MS Excel and e-mailExcellent interpersonal skills with the abilit y to communicateeffectively both orally and in writingAbility towork wel l with others – strong teamwork skillsMust be flexible and ableto functi onin a work environment where workand schedules maychange tomeet the ne eds of the patientDemonstrated ability to work well with customers and d eliver excellentcustomer serviceAbility to control and manage a phone ca llBi-lingual preferredKnowledge of DUHS billing preferred Minimum Qualifications Education Work requires knowledge of basic grammar and mathematical principles normally required through a high school education. Two-year college degree preferred. Experience A minimum of three years direct customer service or call center preferred. 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 Inbound to outbound call center experience preferred. Working knowledge of Maestro Care system preferred. Degrees, Licensures, Certifications N/A   Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual’s age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.   Duke aspires to create a community built on collaboration, innovation, creativity, and belonging.

Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.   Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essentialjob functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.  

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