Cust Svc Dispute Resol Analyst / PA Customer Service

Hartford Healthcare•Farmington, CT

About The Position

The Customer Service Dispute Resolution Analyst is responsible for the analysis, investigation, and resolution of all system-wide customer service requests requiring a second level of review. This individual will assess patient complaints from a holistic perspective, considering charging, billing, documentation, reimbursement, and posting, while collaborating with other departments within and outside of Revenue Cycle. The role requires critical thinking to determine appropriate escalation for unresolved issues and maintaining communication with all involved parties. Excellent communication, empathy, and the ability to de-escalate patients are paramount, as is educating patients on healthcare billing and reimbursement intricacies. The analyst must utilize experience from various facets of the healthcare revenue cycle, including A/R, Government and Commercial Insurance, Federal and State Regulations, and self-pay billing and collections, demonstrating initiative to research and resolve issues to completion on the patient's behalf.

Requirements

Minimum Associate's Degree.
Minimum 3-5 years of experience including insurance and self-pay billing, remit processing, patient access and/or collections experience.
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.
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.

Nice To Haves

Preferred Bachelor's Degree.
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.
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, using a patient-centric approach to answer questions and provide information.
Investigates and analyzes patient inquiries/disputes surrounding charging, coding, payments, locations, services, insurance coverage, etc., working with individuals at various levels of the organization to find resolution.
Maintains a thorough, organized, and updated electronic listing of dispute statuses, accessible to management.
Establishes and maintains successful communication and interaction with members of departments vital to successful patient resolution, including Patient Relations, Privacy and Compliance, Risk Management, HIM, Charge, A/R Follow Up, Denials, Coding, Remit, Site Managers, Practice Managers, and Vendor Contacts and Liaisons.
Takes ownership of all escalated patient complaints and their resolution, ensuring adherence to timely, compliant, and quality standards.
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, and scripting 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.
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.