Customer Service Representative

Position Details Position: Customer Service Representative Location: Houston, TX Remote Status: On-Site Job Id: 119-CS # of Openings: 2 Job Summary The Customer Service Representative is responsible for responding to patient account inquiries in compliance with corporate collections policies, processing patient payments, and generating patient statements. Responsibilities Answer incoming phone calls from customers and determine the type of assistance needed (benefit and eligibility, billings and payments, authorizations for treatment, explanation of benefits). Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems. Own problems through to resolution on behalf of the customer/patients in real time through comprehensive and timely follow‑up. Review and research incoming healthcare claims for patients by navigating multiple computer systems and platforms and verify the data necessary for answering any and all questions regarding their claim. Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures of the benefit plan. Communicate and collaborate with patients to resolve issues, using clear, simple language to ensure complete understanding of their bill/statement. Review and sign all written instructions for any duties; duties may change with ample notice. Meet performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance. Problem solve by identifying and resolving patient billing issues. Demonstrate excellence in customer service when speaking with patients on the phone. Engage in continued medical education to stay abreast of current issues, trends, and changes in laws and regulations governing medical billing. Provide support to other members of the billing department team as needed. Perform other duties as assigned. Competencies Analytical – Synthesizes complex or diverse information; collects and researches data; uses intuition and experience to complement data; designs workflows and procedures. Design – Generates creative solutions; translates concepts and information into images; uses feedback to modify designs; applies design principles; demonstrates attention to detail. Problem Solving – Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem‑solving situations; uses reason even when dealing with emotional topics. Technical Skills – Assesses own strengths and weaknesses; pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others. Customer Service – Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments. Interpersonal Skills – Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things. Oral Communication – Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings. Written Communication – Writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; reads and interprets written information. Teamwork – Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; builds morale and group commitments to goals and objectives; supports everyone's efforts to succeed. Ethics – Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically; upholds organizational values. Organizational Support – Follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values; benefits organization through outside activities; supports affirmative action and respects diversity. Motivation – Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles; measures self against standard of excellence; takes calculated risks to accomplish goals. Planning/Organizing – Prioritizes and plans work activities; uses time efficiently; plans for additional resources; sets goals and objectives; organizes or schedules other people and their tasks; develops realistic action plans. Education Requirements High School Diploma Experience Requirements 1 year of experience in customer service in a medical environment such as a clinic, hospital, or ER. Knowledge, Skills & Abilities Knowledge of principles and processes for providing customer services, including customer needs assessment, meeting quality standards, and evaluating customer satisfaction. Knowledge of medical billing and collection practices. Knowledge of basic medical coding and third‑party operating procedures and practices. Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations. Experience with EMR, EDI, and commercial insurance company systems. Ability to represent the company in a professional manner and handle patient issues with sensitivity and confidentiality. Detail‑oriented and accurate data entry skills. Strong organizational skills and ability to prioritize workload. Bi‑lingual is helpful but not required. Must be able to write and speak effectively in English. Must demonstrate interpersonal skills with all levels of the billing and management team. Must be able to work well in a team environment. Must have basic computer literacy, including keyboarding skills, ability to utilize Outlook, and navigate a Windows environment. Working Environment Ability to work in a fast‑paced, high‑volume, and dynamic environment. Able to flex hours and overtime to meet needs related to unanticipated volume, changes, and/or problems. #J-18808-Ljbffr