Patient Calling Associate

The Patient Calling Specialist acts as the main liaison for patients concerning billing, insurance, and account-related questions. This role involves managing both inbound and outbound communications to address patient concerns, update account information, and facilitate payment collections. The specialist is responsible for auditing accounts, verifying insurance coverage, processing adjustments and refunds, and ensuring all documentation is accurate and compliant with organizational and regulatory standards. Collaboration with internal billing and insurance teams is essential to resolve complex account issues efficiently.

Key Responsibilities:
- Serve as the primary contact for patients regarding billing, insurance, and account inquiries.
- Manage inbound and outbound calls to resolve patient concerns and provide account updates.
- Update and verify Coordination of Benefits (COB) information to support accurate claim processing.
- Collect patient payments and establish payment arrangements following organizational policies.
- Conduct account follow-ups on outstanding balances to promote timely collections.
- Audit patient accounts to identify discrepancies, errors, or missing information.
- Verify insurance coverage, eligibility, and benefit details as required.
- Process account adjustments, corrections, and patient refunds accurately.
- Maintain thorough documentation of all patient interactions and account updates within the billing system.
- Adhere to established collection protocols while maintaining professionalism and patient confidentiality.
- Ensure compliance with HIPAA regulations and organizational standards.
- Collaborate with billing and insurance teams to address and resolve complex account issues.

Required Qualifications:
- High School Diploma or GED required; PharmD also accepted.
- 1–3 years of healthcare accounts receivable (AR) and patient calling experience, including insurance follow-ups, patient communication, insurance verification, and collections.
- Experience with denial resolution and appeals.
- Familiarity with Medicare, Medicaid, and commercial payers.
- Knowledge of medical billing, patient accounts, and insurance processes.
- Ability to handle inbound and outbound billing-related calls professionally.
- Experience collecting payments and setting up payment arrangements.
- Skill in auditing accounts and verifying secondary insurance.
- Understanding of collection procedures and compliance requirements.
- High attention to detail in documentation and account updates.
- Strong organizational and problem-solving skills.

Preferred Qualifications and Additional Skills:
- Associate or Bachelor’s degree in Healthcare, Allied Health, or Business preferred.
- Professional degrees such as MBBS/MD, PharmD, BSN, PA, or NP are advantageous.
- Healthcare certifications like CPC, CCS, CMA/RMA, or CBCS are preferred.
- Working knowledge of CPT, ICD-10, and HCPCS coding.
- Familiarity with software and portals such as TrueBridge, Availity, eCW, and other insurance platforms.
- Experience in hospice, home health, or medical billing AR is highly desirable.
- Ability to manage motor vehicle claims and coordinate with law firms when necessary.

This position requires a detail-oriented individual with strong communication skills and a solid understanding of healthcare billing and insurance processes. The ideal candidate will be adept at managing patient interactions professionally while ensuring compliance with all regulatory standards.