Customer Service Representative - Customer Service - FT - Day

Position Status:
Full time
Shift:
First Shift (Days - Less than 12 hours per shift) (United States of America)
Hours per week:
40
Job Information
Exemption Status: Non-Exempt

A Brief Overview
The Customer Service Representative plays a critical role in the healthcare revenue cycle by providing exceptional service to patients, families, providers, and internal teams. This position is responsible for resolving billing, payment, and insurance-related inquiries across multiple communication channels, while ensuring compliance with healthcare regulations and organizational policies.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree or equivalent undergraduate hours preferred. Preferred

Experience Qualifications

• 3 years Experience in healthcare financial services, healthcare registration services or related healthcare experience. Required

Skills and Abilities

• Working knowledge of basic medical terminology preferred.
• Keyboarding or typing skill of at least 30 wpm strongly desired.
• Proficiency in Microsoft Office (Word, Excel), email, and patient accounting systems preferred.
• Ability to read, analyze, and interpret healthcare regulations, payer correspondence, and technical documentation.
• Detailed knowledge of major third-party billing and contract requirements (required)
• Ability to work independently with strong analytical and problem-solving skills utilized to determine work prioritization, coordination, application of departmental procedures and resolve complex customer service issues. (Required proficiency).
• Strong written and verbal communication skills; able to present information clearly and respond effectively to patients, providers, and leadership.
• Proficiency in basic math, including calculations involving discounts, interest, and percentages; ability to apply basic algebraic concepts.
• Excellent interpersonal skills, with the ability to remain calm, respectful, and professional under pressure.
• Team-oriented mindset with a commitment to continuous improvement and patient-centered service

What you will do

• Respond to incoming calls, emails, and in-person inquiries to assist patients, families, and providers with billing, payment, and account-related concerns.
• Explain in depth to patients what their responsibility is (i.e.: deductible, co-insurance, copayments).
• Promptly follow up with appropriate parties to effectively resolve customer questions and problems. Maintain professionalism and empathy in all interactions.
• Accurately process payments, set up payment plans.
• Accurately apply uninsured, prompt pay, and ministry discounts in accordance with policy and productivity standards.
• Thoroughly research and resolve identified payment discrepancies in a timely manner including identifying and correcting posting errors (i.e. money applied to wrong account).
• Consistently and accurately documents accounts with activities as needed in a timely manner.
• Verifies accuracy of patient demographic and insurance information with patient or family members, documents and updates as necessary.
• Pre-screen patients for financial assistance or charity programs, provide applications, and respond to related inquiries in a timely and compassionate manner.
• Verify insurance eligibility, benefits, and network status. Coordinate multiple coverages and ensure compliance with Medicare, Medicaid, and other federal healthcare regulations.
• Clearly communicate the organization's participating insurance plans to patients and refer them to alternative providers when necessary.
• Serve as a liaison between patients and internal teams such as Patient Experience, PFS management, or other departments to address complaints and determine appropriate resolutions.
• Ensure all customer concerns are handled in compliance with organizational policies, while upholding patient and employee rights, including confidentiality of health and personnel issues.
• Collaborate with internal departments and physician offices to ensure accurate and timely claims processing.
• Reconcile accounts, resolve denials, and pursue outstanding balances using payer remits, contracts, and policies. Identify and report patient and insurance credits to the appropriate department for resolution.
• Accurately calculate and communicate patient and insurance liabilities across all payer types. Determines correct contractual allowances.
• Attends and participates at departmental team meetings, workgroups and other organizational educational programs.
• Identify and investigate duplicate Guarantor Accounts, then merge them to support timely and accurate self-pay billing.
• Create and explain good faith estimates for all patients, including self-pay and out-of-network cases. Educate patients on anticipated balances and payment expectations to support informed financial decisions.
• Identify and notify management of customer service issues and potential process/system problems that cause billing and payment errors and assists in improvement implementation as requested.

Required for All Jobs

• Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
• Performs other duties as assigned

Patient Facing Options

• Position is Not Patient Facing

Remote Work Guidelines

• Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.
• Stable access to electricity and a minimum of 25mb upload and internet speed.
• Dedicate full attention to the job duties and communication with others during working hours.
• Adhere to break and attendance schedules agreed upon with supervisor.
• Abide by Stormont Vail's Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Remote Work Capability

• Hybrid

Scope

• No Supervisory Responsibility
• No Budget Responsibility No Budget Responsibility

Physical Demands

• Balancing: Occasionally 1-3 Hours
• Carrying: Occasionally 1-3 Hours
• Climbing (Stairs): Rarely less than 1 hour
• Crawling: Rarely less than 1 hour
• Crouching: Rarely less than 1 hour
• Eye/Hand/Foot Coordination: Occasionally 1-3 Hours
• Feeling: Occasionally 1-3 Hours
• Grasping (Fine Motor): Frequently 3-5 Hours
• Grasping (Gross Hand): Frequently 3-5 Hours
• Handling: Occasionally 1-3 Hours
• Hearing: Occasionally 1-3 Hours
• Kneeling: Rarely less than 1 hour
• Lifting: Occasionally 1-3 Hours up to 25 lbs
• Pulling: Occasionally 1-3 Hours up to 25 lbs
• Pushing: Occasionally 1-3 Hours up to 25 lbs
• Reaching (Forward): Occasionally 1-3 Hours up to 25 lbs
• Reaching (Overhead): Occasionally 1-3 Hours up to 25 lbs
• Repetitive Motions: Frequently 3-5 Hours
• Sitting: Frequently 3-5 Hours
• Standing: Occasionally 1-3 Hours
• Stooping: Occasionally 1-3 Hours
• Talking: Occasionally 1-3 Hours
• Walking: Occasionally 1-3 Hours

Working Conditions

• Burn: Rarely less than 1 hour
• Chemical: Rarely less than 1 hour
• Combative Patients: Rarely less than 1 hour
• Dusts: Rarely less than 1 hour
• Electrical: Rarely less than 1 hour
• Extreme Temperatures: Rarely less than 1 hour
• Infectious Diseases: Rarely less than 1 hour
• Mechanical: Rarely less than 1 hour
• Needle Stick: Rarely less than 1 hour
• Noise/Sounds: Occasionally 1-3 Hours
• Other Atmospheric Conditions: Rarely less than 1 hour
• Poor Ventilation, Fumes and/or Gases: Rarely less than 1 hour
• Radiant Energy: Rarely less than 1 hour
• Risk of Exposure to Blood and Body Fluids: Rarely less than 1 hour
• Risk of Exposure to Hazardous Drugs: Rarely less than 1 hour
• Hazards (other): Rarely less than 1 hour
• Vibration: Rarely less than 1 hour
• Wet and/or Humid: Rarely less than 1 hour

Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.

Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.