The Customer Service Specialist I is responsible for handling and resolving incoming phone calls from patients, insurance carriers and or physician offices. The Customer Service Specialist must exhibit professional and courteous behavior at all times during patient and/or client interaction.
Expeditiously handle large volume of calls and perform work in a timely manner.
Attempts to collect full payment from patient or guarantor in a professional and courteous manner.
Establishes payment arrangements per guidelines. Documents terms in billing system.
Applies payments collected over the phone to each date of service.
Handles customer inquiries, disputes and complaints in a professional and courteous manner. Escalates contentious complaints to supervisor or higher management.
Obtains all insurance, demographic, guarantor information and updates patient profile as well as bill third party payers as appropriate.
Follows communication procedures, guidelines and policies.
High school graduate or GED certificate is required.
A minimum of 6 months’ experience in a physician billing or third party payer environment.
Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner.
Must demonstrate an understanding of contracts, insurance benefits, exclusions and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations.
Candidate must demonstrate the ability to understand and navigate the payer adjudication process.
Must demonstrate effective communication skills both verbally and written.
Ability to multi-task, prioritize, and manage time effectively.
Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
Ability to work independently.
Requires passing a system competency assessment.
The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.