Healthcare Customer Service Representative

Job Title: Customer Service Representative *BILINGUAL PREFERRED*

Reports to: SBO Manager and Director

Summary: The Healthcare Customer Service Representative plays a critical role in supporting the Single Billing Office (SBO) by providing excellent customer service to patients and conducting self-pay collections. This dual-function role involves managing both inbound and outbound patient calls, responding to billing inquiries, negotiating payment plans, and ensuring compliance with all regulatory guidelines including HIPAA, FDCPA, and internal policies.

The ideal candidate is a self-starter with strong communication skills, high emotional intelligence, and a solid background in healthcare billing and collections. This position requires an understanding of insurance billing, payment posting, and patient advocacy with a goal-oriented and empathetic approach.

Essential Duties and Responsibilities:

 Customer Service:

• Respond to inbound calls, emails, and written inquiries from patients regarding billing questions, statement explanations, and payment options.
• Clarify insurance coverage, update patient demographics, and explain outstanding balances or payment obligations.
• Resolve patient disputes with professionalism and empathy; conduct service recovery where necessary.
• Route and follow up on complex billing issues including coding disputes or provider charge questions.

Self-Pay Collections:

• Make outbound calls to patients to follow up on self-pay balances, aged accounts, and defaulted payment plans.
• Set up and manage payment plans in Epic, including converting legacy account balances from McKesson or other systems.
• Negotiate prompt-pay discounts and settlements within department guidelines.
• Research and process returned mail by updating addresses and contact information.
• Collect payments securely over the phone and document activity to maintain compliance and transparency.

Administrative and Analytical Tasks:

• Resubmit insurance claims and follow up on unpaid balances as needed.
• Review accounts for billing accuracy, insurance coverage, and contract compliance.
• Use multiple systems such as Epic, McKesson (HealthQuest), Cerner (PAM), Availity, Ecare, HealthPay24, and Medicare Connex for account management and research.
• Process bankruptcy notices, charity applications, and other account exceptions appropriately.
• Provide support to the SBO Customer Service team when needed.

Knowledge, Skills & Abilities:

• Working knowledge of Epic and other electronic billing systems (McKesson, Cerner, etc.)
• Understanding of billing procedures, UB04 and HCFA 1500 forms, CPT/ICD/HCPCS/DRG codes.
• Strong understanding of self-pay workflows, insurance processes, and charity or discount policies.
• Familiarity with FDCPA, HIPAA, 501r, and Fair Patient Billing Act regulations.
• Ability to read and interpret Explanation of Benefits (EOBs) and patient account histories.
• Exceptional verbal and written communication skills with a patient-focused attitude.
• Critical thinking, time management, and organizational skills.
• Strong customer service skills with the ability to handle sensitive or difficult conversations.
• Bilingual Spanish-speaking is a plus.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook).

Education and Experience Requirements:

• High School Diploma or GED required.
• 2–4 years of experience in a medical billing, collections, or healthcare customer service role.
• Prior call center or hospital/professional billing environment experience strongly preferred.
• Demonstrated ability to analyze and resolve complex billing issues efficiently and compassionately.

Work Environment & Schedule:

• Full-time, Monday to Friday, 8-hour shifts.
• Occasional overtime may be required depending on department needs.
• Hybrid or on-site options may vary depending on organizational policy.