Customer Service Specialist

Customer Service Specialist

The Revenue Cycle Manager Customer Service Specialist role is a key liaison between patients, insurance carriers, and internal departments. The Customer Service Specialist will be responsible for providing exceptional customer service while managing patient inquiries related to accounts, insurance, and billing. They serve as an RCM expert and resource to Billing Call Center, Operations and Resource Center teams for patient related billing inquiries.

Performance

• Handles customer calls to resolve inquiries in a timely and accurate manner in a patient focused manner that enhances the experience of patients and their families.
• Assist patients with billing inquiries in a professional and empathetic manner
• Verify insurance information and assist in claim resolution, including following up on unpaid or denied claims
• Post payments and adjustments to patient accounts accurately
• Identify and escalate complex issues to the billing supervisor or the appropriate department
• Process refunds, payment plans, and account corrections when necessary
• Document all communication and actions in the patient's account in a clear and timely manner
• Support the billing team with clerical tasks such as filing, faxing, and data entry
• Support Operations by providing live support when urgent escalations exist at a place of service
• Collaborate with clinical and administrative teams to resolve patient concerns quickly and effectively
• Maintain confidentiality and adhere to HIPAA regulations at all times

Communication and Working Relationships

• Works cross-functionally to maintain and promote an efficient and effective patient inquiry resolution process
• Responds to inquiries from leadership, Operations, staff or physicians in a timely and appropriate manner
• Coordinate communication to leadership of root cause assessment that is contributing to recurring patient escalations

Other

• Perform other duties as assigned

Experience and Knowledge

• High school diploma or equivalent required; associate degree or higher preferred
• Minimum 2 years of experience in a medical office or healthcare billing setting
• Strong understanding of medical billing processes, terminology, and insurance (commercial and government)
• Knowledge of CPT, ICD-10, and HCPCS codes
• Excellent verbal and written communication skills
• Ability to multitask and remain calm in a fast-paced environment
• Proficient in using billing software and Microsoft Office Suite (especially Excel and Outlook)
• Experience with electronic health records (EHR) and practice management systems is a plus

Preferred Skills

• Bilingual (English/Spanish or other) is a plus
• Ophthalmology and/or Ambulatory Surgery Center billing experience
• Familiarity with the appeals and denials process