Customer Service Representative I

Mass General Brigham•Somerville, MA

21h•Hybrid

About The Position

Mass General Brigham is a not-for-profit organization dedicated to patient care, research, teaching, and community service. The Customer Service Representative I position, within Patient Billing Solutions (PBS), reports to the Manager and is responsible for reviewing and resolving guarantor account balances. This involves handling both inbound and outbound contacts via phone, written correspondence, email, or secure Epic in-basket requests. The primary goal is to provide timely responses to guarantor inquiries, which often include securing payments, making adjustments, initiating insurance processing reviews, refunding balances, or resolving registration, demographic, or insurance coverage issues. Staff may be assigned to specific Work Queues and will typically answer phone calls through an Automated Call Distribution (ACD) process. The role requires expertise in multiple Epic modules (HB Resolute, PB Resolute, Registration/ADT, Credit Specialist training) and a broad knowledge of medical billing and insurance processing. Representatives must be able to address a wide range of issues for all payers, communicating professionally and clearly, while strictly adhering to HIPAA Privacy guidelines. The ultimate objective is to resolve guarantor concerns and enhance their overall experience with Mass General Brigham.

Requirements

High School diploma or GED equivalent required
Effective communication, organizational and problem-solving skills required
1-3 years relevant experience in customer service or collections in a health care setting (alternative work experience or training in lieu of experience may be considered)

Nice To Haves

Associates Degree preferred
Epic billing systems knowledge preferred

Responsibilities

Respond to patient/guarantor/Customer 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/insurance information and fiscal registrations to verify the patient’s responsibility for all outstanding balances.
Contact other departments at MGB/RCO/entities, payers, affiliated physician organizations and other vendors (Collection Agencies and other outsource agents) for verification.
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, application, or referring patients to Financial Counseling.
Provide timely, professional, and accurate account review, analysis, and resolution of patient inquiries, resolving issues during the initial telephone call whenever possible.
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 complete 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, TRAC and QUIC.
Look up information in other support systems as needed 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.
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.
Provide cordial, courteous and high-quality service to callers, listening attentively to patients by placing customer concerns ahead of oneself.
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.
Follow through on commitments and achieves desired results, exhibiting sound judgment, obtaining the facts, examining options, gaining support and achieving positive outcomes.
Properly document every account that is accessed with clear concise notes.
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, following 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, following 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.
Support and demonstrate the values of the MGB and affiliates by conducting activities in an ethical manner with integrity, honesty, and confidentiality.
Demonstrate a positive, open-minded, can-do attitude, representing a team perspective and willingness and enthusiasm to collaborate with others.
Enthusiastically promote a cooperative team environment to provide value to all customers, listening and interacting tactfully, diplomatically and effectively without alienating others.
Maintain high standards of professional conduct, comply with all applicable MGB Patient Billing Solution policies and procedures, and follow department attendance expectations.
Attend required training.
Consistently answer calls at the average of the daily rate for the team, typically at least 40-50 calls per day.
Maintain a daily list of all accounts accessed and provide supervisor/manager with an account listing of all unresolved issues weekly.
Resolve at least 80% of patient issues without referring the call to the supervisor/manager.
Pass routine quality assurance reviews at an average of >90%.
Perform other duties tasks or projects as assigned, able to work and think independently while being self-motivated.