Customer Service Representative - Customer Service - FT - Day

Position Status:

Full time

Shift:

First Shift (Days - Less than 12 hours per shift) (United States of America)

Hours per week:

40

Job Information
Exemption Status: Non-Exempt

A Brief Overview
The Customer Service Representative plays a critical role in the healthcare revenue cycle by providing exceptional service to patients, families, providers, and internal teams. This position is responsible for resolving billing, payment, and insurance-related inquiries across multiple communication channels, while ensuring compliance with healthcare regulations and organizational policies.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree or equivalent undergraduate hours preferred. Preferred

Experience Qualifications

• 3 years Experience in healthcare financial services, healthcare registration services or related healthcare experience. Required

Skills and Abilities

• Working knowledge of basic medical terminology preferred.
• Keyboarding or typing skill of at least 30 wpm strongly desired.
• Proficiency in Microsoft Office (Word, Excel), email, and patient accounting systems preferred.
• Ability to read, analyze, and interpret healthcare regulations, payer correspondence, and technical documentation.
• Detailed knowledge of major third-party billing and contract requirements (required)
• Ability to work independently with strong analytical and problem-solving skills utilized to determine work prioritization, coordination, application of departmental procedures and resolve complex customer service issues. (Required proficiency).
• Strong written and verbal communication skills; able to present information clearly and respond effectively to patients, providers, and leadership.
• Proficiency in basic math, including calculations involving discounts, interest, and percentages; ability to apply basic algebraic concepts.
• Excellent interpersonal skills, with the ability to remain calm, respectful, and professional under pressure.
• Team-oriented mindset with a commitment to continuous improvement and patient-centered service

What you will do

• Respond to incoming calls, emails, and in-person inquiries to assist patients, families, and providers with billing, payment, and account-related concerns.
• Explain in depth to patients what their responsibility is (i.e.: deductible, co-insurance, copayments).
• Promptly follow up with appropriate parties to effectively resolve customer questions and problems. Maintain professionalism and empathy in all interactions.
• Accurately process payments, set up payment plans.
• Accurately apply uninsured, prompt pay, and ministry discounts in accordance with policy and productivity standards.
• Thoroughly research and resolve identified payment discrepancies in a timely manner including identifying and correcting posting errors (i.e. money applied to wrong account).
• Consistently and accurately documents accounts with activities as needed in a timely manner.
• Verifies accuracy of patient demographic and insurance information with patient or family members, documents and updates as necessary.
• Pre-screen patients for financial assistance or charity programs, provide applications, and respond to related inquiries in a timely and compassionate manner.
• Verify insurance eligibility, benefits, and network status. Coordinate multiple coverages and ensure compliance with Medicare, Medicaid, and other federal healthcare regulations.
• Clearly communicate the organization’s participating insurance plans to patients and refer them to alternative providers when necessary.
• Serve as a liaison between patients and internal teams such as Patient Experience, PFS management, or other departments to address complaints and determine appropriate resolutions.
• Ensure all customer concerns are handled in compliance with organizational policies, while upholding patient and employee rights, including confidentiality of health and personnel issues.
• Collaborate with internal departments and physician offices to ensure accurate and timely claims processing.
• Reconcile accounts, resolve denials, and pursue outstanding balances using payer remits, contracts, and policies. Identify and report patient and insurance credits to the appropriate department for resolution.
• Accurately calculate and communicate patient and insurance liabilities across all payer types. Determines correct contractual allowances.
• Attends and participates at departmental team meetings, workgroups and other organizational educational programs.
• Identify and investigate duplicate Guarantor A