About this role
Division/Department – MSO
Reports to – Customer Service & Collections Manager
GENERAL JOB DESCRIPTION
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 financial experience by providing timely, professional, and accurate responses to billing-related concerns. The Customer Service Representative works under the direction of the Customer Service & Collections Manager 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
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.