Call Center Representative-Remote TX Resident

The Customer Service Representative is responsible for handling patient and payer inquiries regarding medical billing, insurance claims, and account resolutions. This role ensures a positive patient's financial experience by providing timely, professional, and accurate responses to billing-related concerns.

The Customer Service Representative works under the direction of the Revenue Cycle Manager Patient AR to support revenue cycle operations and enhance the efficiency of billing processes.

Essential Duties and Responsibilities

• Handle inbound and outbound calls regarding patient balances, insurance claims, and billing inquiries.
• Provide clear and empathetic explanations of charges, payment options, and account statuses.
• Assist patients with setting up payment plans and making payments.
• Research and resolve billing discrepancies, denials, and adjustments.
• Work with insurance carriers to verify claims status and escalate issues as
• Maintain a professional and courteous demeanor in all patient interactions.
• Ensure timely and effective resolution of patient and payer concerns.
• Document all customer interactions accurately in the system.
• Adhere to HIPAA guidelines and company policies regarding patient information security.
• Follow Fair Debt Collection Practices Act (FDCPA) guidelines when addressing outstanding balances.
• Work closely with the billing, collections, and revenue cycle teams to improve patient financial engagement.
• Provide feedback to management on recurring billing issues and recommend solutions.
• Participate in training and team meetings.
• Support special projects related to billing and collections.

QUALIFICATIONS

Education & Experience

• High school diploma or GED required.
• Minimum of 1 year of experience in healthcare customer service, billing, or insurance claims processing.

Skills & Competencies

• Excellent verbal and written communication skills.
• Basic knowledge of orthopedic-related coding, medical terminology, and insurance procedures preferred.
• Proficiency in Microsoft Office (Excel, Word, Outlook) and Athena software.
• Ability to handle high call volumes and work in a fast-paced environment.
• Strong problem-solving and conflict-resolution skills.
• High attention to detail and ability to follow workflows accurately.

Work Environment & Physical Demands

• Standard office environment with prolonged periods of sitting and computer use.
• Occasional high-stress work requiring interaction with upset patients or insurance representatives.
• Manual dexterity required to operate a keyboard, calculator, and office equipment.