Cust Svc Dispute Resol Analyst / PA Customer Service

Hartford Healthcare•Farmington, CT

19d

About The Position

Position Summary: The Customer Service Dispute Resolution Analyst is responsible for analysis, investigation and resolution of all customer service requests, system-wide requiring a second level review. This individual will be responsible for assessing the patient’s complaint from a holistic perspective, taking into account the charging, billing, documentation, reimbursement, and posting while using an interdisciplinary approach with other departments both within and outside of Revenue Cycle. This individual must possess the critical thinking skills required when determining appropriate escalation to the next level for unresolved and/or outstanding circumstances warranting further involvement of senior leadership. Keeping all parties involved and updated throughout the research phase as well as once finalized. Excellent communication skills will be paramount for interaction with patients and colleagues, including the ability to de-escalate patients, show empathy and compassion, speak professionally, in a manner best suited to the recipient. In addition, educating patients on the intricacies of the billing and reimbursement in healthcare and the resulting patient balances will be an important component of the position. This individual must utilize experience from multiple facets within the healthcare revenue cycle, including, but not limited to: A/R, Government and Commercial Insurance, Federal and State Regulations, self-pay billing and collections, etc. The Dispute Resolution Analyst must exhibit initiative to research and resolve an issue to completion on the patient’s behalf.

Requirements

Minimum: Associates Degree
Minimum: 3-5 years of experience including insurance and self-pay billing, remit processing, patient access and/or collections experience.
Minimum: Fluent in English
Outstanding customer service and interpersonal skills.
Superior communication, organizational, and analytical skills.
Understanding of Hospital and Professional revenue cycle.
Ability to work in a high volume setting and respond to patient inquiries in a timely manner.
Ability to identify and communicate payer and/or system trends.
Knowledge of payer contracts, regulations and guidelines, as well as State and Federal laws relating to billing, collection, and financial assistance procedures.
Familiar with medical and insurance terminology.
Proficient in the use of a computer and relevant hospital software applications.

Nice To Haves

Preferred: Bachelor’s Degree
Preferred: Minimum of 1 year of experience in a multi-entity system with EPIC. Previous experience in patient relations or customer service for a healthcare entity.
Preferred: Fluent in English, Spanish and Polish

Responsibilities

Responds and takes action related to calls, emails, and faxes related to patient billing in a timely and professional manner. Uses a patient-centric approach to answer questions and provide information.
Understands healthcare billing and payer regulations to effectively communicate with patients about charges, payments and adjustments on their account.
Investigates and analyzes patient inquiries/disputes surrounding charging, coding, payments, locations, services, insurance coverage, etc. Works with individuals when appropriate at various levels of the organization to find resolution on patient disputes. This includes managers, directors, clinicians, etc.
Maintains thorough, organized, updated electronic listing of dispute statuses, accessible to management at any time.
Establishes and maintains successful communication and interaction with members of departments vital to successful patient resolution, including, but not limited to: Patient Relations, Privacy and Compliance, Risk Management, HIM, Charge, A/R Follow Up, Denials, Coding, Remit, Site Managers, Practice Managers, as well as Vendor Contacts and Liaisons.
Takes ownership of all escalated patient complaints and their resolution, ensuring adherence to timely, compliant and quality standards set by the department leadership team.
Directs inquiries to appropriate departments if not related to insurance and patient balances.
Works directly with the Customer Service Manager to identify trends, provide improved education, scripting etc. to prevent similar situations and improve patient experiences.
Identifies barriers to efficient departmental operations and takes an active role in developing appropriate solutions using the H3W model.
Must be knowledgeable about Epic Navigation and all self-pay workflows within the department. Ability to analyze accounts related to other self-pay workflows as requested.
Researches and updates self-pay accounts (processes credits, return mail, bankruptcy, addresses, insurances, etc), processing financial assistance applications, and assists with Independence at Home billing.