BAD DEBT REPRESENTATIVE

About Our Organization

Partners Healthcare is an integrated health care system, founded by Brigham and Women's Hospital and Massachusetts General Hospital that offers patients a continuum of coordinated and high-quality care. In addition to its two academic medical centers, Partners system includes community and specialty hospitals, a managed care organization, a physician network, community health centers, home health and long-term care services, and other health care entities. Partners HealthCare is committed to patient care, research, teaching, and service to the community. Partners is one of the nation's leading biomedical research organizations and is a principal teaching affiliate of Harvard Medical School. Partners HealthCare is a non-profit organization. We have opportunities in Finance, Information Systems, Human Resources and many other areas that work behind the scenes in support of the Partners mission.



DETAILS

Location: Charlestown, MA,
Employee Type: full time
Experience: 2 - 5 years
Education: Highschool GED
Travel Required: none

DESCRIPTION

General Overview

Reporting to and working under the general direction of the Manager, the Bad Debt Representative resolves guarantor/patient account balances. The Patient Billing Office’s primary focus 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, dialer system or based on an account work list. The representative utilizes multiple electronic billing and medical retrieval systems as well as knowledge of medical billing to resolve guarantor/patient inquiries. 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. Our goal is to resolve all of the patient’s concerns and maximize guarantor collections 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.


Responsibilities

  

  • Contact the guarantor for accounts that are selected 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, coding accuracy/appropriateness, 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 patient’s 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).  Representative must be fully versed in PHS Credit & Collection Policy and Financial Assistance Policy and must inform patients of all assistance available to them in when making payment arrangements, processing payments, initiating Financial Assistance application, or referring patients to Financial Counseling. 
  • Provide timely, professional, and accurate account review, analysis, and resolution of patient inquiries.  Whenever possible, resolve issues during the initial telephone call.  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 including the completion of required supplemental information such as race/sex information 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 a variety of systems including hospital legacy billing systems (BICS/PATCOM/Soarian/Invision), TRAC, QUIC, physician organization billing systems (IDX), document imaging (Sovera), eligibility verification systems (NEHEN, payer web sites) and other document backup (Document Direct) in order to analyze claims, resolve issues and respond to the patient’s 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 patient’s inquiry. 
  • Provide cordial, courteous and high quality service to callers.  Listen 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 correspondence, telephone and email, from patients and other departments within PHS.  Utilize customer service, collections, and billing experience to gather and interpret relevant information to resolve patient account issues and complaints. 
  • Ensure accurate patient billing 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.
  • Identify root cause(s) of guarantor/patient inquiries and report findings to management for appropriate resolution to future accounts.  Follow up on individual issues to assure they are completed.  Record and classify all communications in the appropriate systems for statistical reporting.
  • Submit patient credit balances that need to be refunded to the appropriate parties for action by verifying the reason for the credit.
  • 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 PHS HIPAA confidentiality policy.
  • Supports and demonstrates the values of the PHS 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.
  • Follows through on commitments and achieves desired results.  Exhibits sound judgment, obtains the facts, examines options, gains support, and achieves positive outcomes.
  • Maintain high standards of professional conduct.  Comply with the Collections and hospital policies and procedures.  Follow department attendance expectations and arrive for work well prepared at expected time.  Attend required training.
  • Specific Duties
  • Primary accountability is review assigned accounts to determine their suitability for Bad Debt placement and verify the class of bad debt.  Verify that all required reviews have occurred.
  • Engage with guarantors to clarity questions which may occur as part of the review.  Seek to avoid bad debt placements by resolving issues and collecting outstanding balances.
  • Respond to calls from guarantors whose accounts have been placed in collections to resolve issues.  Contact Collection Agencies as needed to coordinate actions or update account status.
  • Review an average of at least 5 MRN/hour for every hour logged into the TRAC work flow system.  Expected to maintain 100% productivity on a monthly average.  Account selection is based on the system priority as determined by the segmentation strategy.  Representative may not skip accounts in their lists.
  • 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 10% of the accounts where there are questions arising from a guarantor contact.
  • Assist with training of new staff via peer to peer training
  • Determine if accounts have met the requirements for Medicare Bad Debt or Emergent Bad Debt and take any necessary actions to process qualified accounts.
  • Performs other duties tasks or projects as assigned.

Qualifications

   

  • 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.
  • 3-5 years relevant experience in customer service and/or collections in a health care setting required.
  • Alternative work experience or training in lieu of experience may be considered. 


 



REQUIREMENTS

Skills/Abilities/Competencies

  

  • Knowledge of Word, Excel, and Outlook sufficient to perform all routine tasks including email, document preparation and worksheet preparation.
  • Familiarity with medical/hospital billing systems and third party payment processes desired
  • Knowledgeable on basic Medicare issues including 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
  • Detail oriented


EEO Statement

Partners HealthCare System is an Equal Opportunity Employer


THIS JOB IS DELETED

COMPANY

Partners HealthCare
Partners Payroll

Charlestown, MA 02129-1131
UNITED STATES