Patient Calling Associate

The Patient Calling Specialist acts as the main liaison between patients and the healthcare organization concerning billing, insurance, and account-related inquiries. This role involves managing both inbound and outbound communications to address patient concerns, update account information, and resolve billing issues. The specialist is responsible for verifying insurance coverage, updating coordination of benefits, collecting payments, and following up on outstanding balances. Additionally, the role requires auditing patient accounts for accuracy, processing adjustments and refunds, and maintaining thorough documentation while adhering to collection protocols and compliance standards.

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 claims processing.
- Collect patient payments and establish payment arrangements according to organizational policies.
- Conduct follow-ups on outstanding balances to facilitate 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 with accuracy.
- Document all patient interactions and account updates comprehensively in the billing system.
- Adhere to established collection protocols while maintaining professionalism and patient confidentiality.
- Ensure compliance with HIPAA regulations and organizational standards.
- Collaborate with internal billing and insurance teams to resolve complex account issues.

Required Qualifications:
- High School Diploma or GED required; PharmD is acceptable.
- 1–3 years of experience in healthcare accounts receivable (AR) and patient calling, including insurance follow-ups, patient calls, insurance verification, and collections.
- Experience with denial resolution and appeals processes.
- Familiarity with Medicare, Medicaid, and commercial payers.
- Knowledge of CPT, ICD-10, and HCPCS coding.

Preferred Qualifications and Experience:
- 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.
- Experience in hospice, home health, or medical billing AR is highly desirable.
- Proficiency with billing and insurance platforms such as TrueBridge, Availity, eClinicalWorks (eCW), and various insurance portals.
- Understanding of collection procedures and compliance requirements.
- Ability to manage motor vehicle claims and coordinate with law firms.
- Strong patient communication and customer service skills.
- High attention to detail in documentation and account updates.
- Excellent organizational and problem-solving abilities.

This role is essential for ensuring smooth patient account management and supporting the financial health of the organization through effective communication, accurate billing practices, and compliance adherence.