As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, MGB supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.
Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
Reporting to and working under the general direction of a Manger or Senior Manager, Collections staff in Patient Billing Solutions (PBS) primarily initiate contact with guarantors seeking to resolve outstanding self-pay account balances. Contacts are generally by phone, written correspondence, and/or email Staff also respond to in-bound patient contacts that are in response to an automated collection notice (auto-dialer or automated letter) in response to other patient contact letters regarding payment plans, Coordination of Benefits or other issues preventing an insurance payment. Account resolution takes many forms including securing payments, updating account information, making appropriate adjustments, initiating refunds, or initiating reviews by other teams in Revenue Cycle Operations including the professional billing teams. Account information updates include demographic and financial information. Work is primarily driven by system-based work queues within EPIC. Staff will have some responsibility to answer phone calls via an Automated Call Distribution (ACD) process. Account resolution typically requires expertise in multiple modules in Epic, HB/PB accounts, CRM Registration/ADT and Credit Specialist training. Broad based knowledge of medical billing and insurance processing is preferred. Staff must be diligent in following HIPAA Privacy guidelines and follow all applicable MGB policy and procedures. The primary goal of PBS is to resolve the guarantor's concerns focusing on providing excellent customer service that enhances the guarantor's overall experience with MGB.
Principal Duties and Responsibilities
- Contact the guarantor for accounts in assigned work queues with the goal of clearing the accounts in a timely manner. Initial contact is by phone which may require leaving a message that meets privacy and security guidelines. Respond to patient/guarantor concerns during any contact. These concerns may span a wide range of issues including payer denials, coding accuracy, secondary billing, Coordination of Benefits, verification of co-payments/co-insurance/deductibles and verification/updates to demographic/insurance information. The overall goal is to validate the guarantor balance and ensure that the guarantor understands the reasons for the balance. Verification process often includes contacting other departments at MGB including hospital and professional billing teams generally via Epic bases WQ and CRM processes.
- Representative must 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, initiating Financial Assistance application Representative must follow guidelines to ensure MGB compliance with MA collections regulations. Ensure required documentation of issues is complete, accurate, and timely. Insure the review of all relevant information to resolve patient account issues/complaints. Protect and preserve confidentiality and integrity of all information according to MGB HIPAA confidentiality policy
- Maintain assigned guarantor payment plans to ensure that payments are made regularly and resolve issues with suspended or rejected payment methods attached to auto-pay payment plans. Follow up on assigned accounts which may require that the patient be contacted to update their payment plan including adding new accounts to the payment plan.
- Begin designated guarantor contacts by creating a 'CRM' folder to classify the reason for the contact. Seek to identify root cause(s) of guarantor/patient inquiries and document them as part of the CRM process. Follow up on individual issues CRM's to assure they are completed. Flag unusual items or trends and alert the supervisor or manager if there are sensitive issues.
- Access information from a range of supporting systems or information sources including, but not limited to document imaging (OnBase), eligibility verification systems (NEHEN, payer web sites) and other document backup (SharePoint) to identify root cause issues
- Provide timely, professional, and accurate account review, analysis, and resolution of patient inquiries 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, generally using Account Activities/CRM.
- Whenever possible, resolve issues during the initial patient contact. 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 Resolve complex issues with minimal external or supervisory involvement.
- Use department SharePoint tool as needed to initiate a Privacy Incident.
- 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.
- Collections, and billing experience to gather and interpret relevant information to resolve patient account issues and complaints.
- Follow guidelines to correctly assess HSN Surcharges for applicable services. Respond to guarantor questions regarding the nature of the surcharge.
- Supports and demonstrates the values of PHS and affiliates by conducting work activities in an ethical manner with integrity, honesty, and confidentiality. Demonstrates a positive can-do attitude. Represents a team perspective and willingness and collaborate with others. Enthusiastically promote a cooperative team environment.
- Specific Accountabilities:
- Work an minimum of 5 Guarantor accounts (MRN)/per hour for every hour logged into the Epic (assigned work queue) system. Expected to maintain 100% productivity on a monthly average.
- Maintain an average score of 90% for all quality assurance reviews that are typically performed.
- Use/s the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration
- Other duties as assigned
- Hours; Monday thru Friday 8:00am to 4:30pm standard eastern time
- 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.
- 1-3 years' relevant experience in customer service or collections in a health care setting desired.
- A combination of education and experience may be substituted for requirements
- Knowledge of Word, Excel, and Outlook sufficient to perform all routine tasks including email, document preparation and worksheet preparation.
- Possess strong interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization
- Ability to successfully negotiate and collaborate with others of different skill sets, backgrounds an levels within and external to the organization
- Strong problem solving and negotiation skills
- Ability to effectively conduct meetings, both formal and informal
- Requires minimal direction from leadership and possesses the ability to learn quickly
Mass General Brigham is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard torace, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.