Customer Service Specialist II is responsible for handling and resolving incoming phone calls from patients, insurance carriers and or physician offices. Responsibilities will include collections of outstanding patient balances, establishing payment arrangements, updating patient and guarantor accounts with new demographic and insurance coverage information.
Attempts to collect full payment from the patient or guarantor in a professional and courteous manner.
Establishes payment arrangements per guidelines. Documents terms in billing system.
Applies of 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.
Provides appropriate response immediately or indicate a call back with a business day as appropriate.
Obtains all insurance, demographic, guarantor information and updates patient profile as well as bill third party payers as appropriate.
Meets productivity and quality targets.
High school graduate or GED certificate is required.
A minimum of 1 years’ experience in a physician billing or third party payer environment.
Candidate must demonstrate 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.)