[Remote] RCM - Patient Customer Service Specialist

Note: The job is a remote job and is open to candidates in USA. Lifeline Connections is a community-based behavioral health organization that specializes in providing confidential and compassionate care to individuals who experience substance use and/or mental health conditions. The RCM - Patient Customer Service Specialist is responsible for providing exceptional service to patients, assisting with insurance verification, payment arrangements, and resolving billing inquiries.

Responsibilities

• Verifies patient insurance eligibility and benefits through payer websites, electronic verification tools, and direct contact with health plans; follows up as necessary to confirm coverage and resolve eligibility issues
• Responds to patient inquiries regarding medical billing, insurance coverage, account balances, payment options, and related financial matters
• Contacts patients regarding outstanding balances, denied claims, payment requests, and overdue accounts; establishes and monitors payment arrangements as appropriate
• Processes and submits patient refund requests in accordance with established policies and procedures
• Serves as the primary backup for the RCM Medical Payment Posting Specialist
• Maintains daily account follow-up worklists and assigned account inventories while meeting established productivity and quality standards
• Identifies, researches, and resolves credit balances, missing payments, unapplied cash, and other account discrepancies
• Audits patient accounts to ensure accuracy and completeness of billing and payment information
• Conducts collection activities for unpaid patient balances in accordance with organizational policies and applicable regulations
• Provides outstanding customer service to patients, staff, providers, and external stakeholders
• Answers incoming telephone calls, emails, and other communications, directing inquiries appropriately and ensuring timely resolution
• Determines patient eligibility for Sliding Fee Scale discounts and other available funding sources
• Assists patients with funding applications and provides Good Faith Estimates as required by applicable regulations
• Documents all activities, communications, and findings in accordance with established policies and procedures, ensuring the integrity and completeness of account records
• Maintains current knowledge of organizational policies, payer requirements, industry standards, and applicable federal and state regulations
• Establishes and maintains professional, effective working relationships with patients, coworkers, providers, and external contacts
• Maintains strict confidentiality and complies with all applicable HIPAA requirements and 42 CFR Part 2 regulations
• Demonstrates strong problem-solving skills and exercises sound judgment in resolving patient account and billing issues
• Maintains knowledge of patient statement systems and ensures patient statements are generated and distributed accurately and timely
• Communicates professionally and effectively, both verbally and in writing, with patients, insurance companies, coworkers, and leadership
• Effectively prioritizes workload to meet multiple deadlines, productivity standards, and organizational objectives
• Functions as an integral member of the Revenue Cycle Management team and collaborates effectively with other departments
• Supports and adheres to agency policies, procedures, and organizational values
• Participates in special projects and performs other duties as assigned by the supervisor

Skills

• Minimum of one (1) year of customer service experience required, preferably in a healthcare or patient-facing environment
• Working knowledge of medical billing practices, insurance claim processing, Medicaid programs, ICD-10 and CPT coding, HCFA 1500 and UB-04 claim forms, and payer requirements for reimbursement
• Understanding of healthcare insurance eligibility, benefits verification, patient financial responsibility, and collections processes
• Proficiency in Microsoft Office applications, particularly Microsoft Excel, with the ability to create, maintain, and analyze reports accurately
• Demonstrated ability to maintain superb attendance and reliability
• Strong interpersonal skills with the ability to work collaboratively and effectively as part of a team
• Highly organized and detail-oriented, with strong analytical, problem-solving, and critical-thinking abilities
• Excellent verbal and written communication skills, including the ability to communicate professionally with patients, insurance representatives, coworkers, and leadership
• Ability to manage multiple priorities, meet deadlines, and perform effectively in a fast-paced environment while maintaining accuracy and quality standards
• Minimum of one (1) year of experience in medical billing, collections, healthcare revenue cycle operations, or a nonprofit healthcare environment preferred. An associate's degree, certification, or formal training in Medical Billing, Health Information Management, or a related field may be substituted for experience
• Experience with electronic health record (EHR) systems required; prior experience with Qualifacts CareLogic preferred

Benefits

• Multiple options for medical, dental, and vision coverage for employees and their eligible dependents
• Employer-paid Short Term Disability, Long Term Disability, and Life Insurance
• Access to supplemental coverage options
• Full-time employees and eligible part-time employees may also enroll in our 401(k) retirement plan
• Generous paid time off
• PTO at competitive accrual rates that increase with years of service
• Paid holidays and personal holidays

Company Overview