RCM - Patient Customer Service Specialist

RCM- Patient Customer Service Specialist Non-Exempt Position

The Revenue Cycle Management (RCM) Patient Customer Service Specialist is responsible for providing exceptional service to patients with commercial insurance coverage and self-pay accounts. This position supports the patient financial experience throughout the revenue cycle by verifying insurance eligibility and benefits, assisting with payment arrangements, resolving account issues, and serving as a primary point of contact for patient billing inquiries. The incumbent performs the following duties with a high degree of independence:

• Verifies patient insurance eligibility and benefits through payer websites, electronic verification tools, and direct contact with health plans; follows up as necessary to confirm coverage and resolve eligibility issues.
• Responds to patient inquiries regarding medical billing, insurance coverage, account balances, payment options, and related financial matters.
• Contacts patients regarding outstanding balances, denied claims, payment requests, and overdue accounts; establishes and monitors payment arrangements as appropriate.
• Processes and submits patient refund requests in accordance with established policies and procedures.
• Serves as the primary backup for the RCM Medical Payment Posting Specialist.
• Maintains daily account follow-up worklists and assigned account inventories while meeting established productivity and quality standards.
• Identifies, researches, and resolves credit balances, missing payments, unapplied cash, and other account discrepancies.
• Audits patient accounts to ensure accuracy and completeness of billing and payment information.
• Conducts collection activities for unpaid patient balances in accordance with organizational policies and applicable regulations.
• Provides outstanding customer service to patients, staff, providers, and external stakeholders.
• Answers incoming telephone calls, emails, and other communications, directing inquiries appropriately and ensuring timely resolution.
• Determines patient eligibility for Sliding Fee Scale discounts and other available funding sources.
• Assists patients with funding applications and provides Good Faith Estimates as required by applicable regulations.
• Documents all activities, communications, and findings in accordance with established policies and procedures, ensuring the integrity and completeness of account records.
• Maintains current knowledge of organizational policies, payer requirements, industry standards, and applicable federal and state regulations.
• Establishes and maintains professional, effective working relationships with patients, coworkers, providers, and external contacts.
• Maintains strict confidentiality and complies with all applicable HIPAA requirements and 42 CFR Part 2 regulations.
• Demonstrates strong problem-solving skills and exercises sound judgment in resolving patient account and billing issues.
• Maintains knowledge of patient statement systems and ensures patient statements are generated and distributed accurately and timely.
• Communicates professionally and effectively, both verbally and in writing, with patients, insurance companies, coworkers, and leadership.
• Effectively prioritizes workload to meet multiple deadlines, productivity standards, and organizational objectives.
• Functions as an integral member of the Revenue Cycle Management team and collaborates effectively with other departments.
• Supports and adheres to agency policies, procedures, and organizational values.
• Participates in special projects and performs other duties as assigned by the supervisor.

Knowledge and Skills Required by the Position:

• Minimum of one (1) year of experience in medical billing, collections, healthcare revenue cycle operations, or a nonprofit healthcare environment preferred. An associate's degree, certification, or formal training in Medical Billing, Health Information Management, or a related field may be substituted for experience.
• Minimum of one (1) year of customer service experience required, preferably in a healthcare or patient-facing environment.
• Working knowledge of medical billing practices, insurance claim processing, Medicaid programs, ICD-10 and CPT coding, HCFA 1500 and UB-04 claim forms, and payer requirements for reimbursement.
• Understanding of healthcare insurance eligibility, benefits verification, patient financial responsibility, and collections processes.
• Experience with electronic health record (EHR) systems required; prior experience with Qualifacts CareLogic preferred.
• Proficiency in Microsoft Office applications, particularly Microsoft Excel, with the ability to create, maintain, and analyze reports accurately.
• Demonstrated ability to maintain superb attendance and reliability.
• Strong interpersonal skills with the ability to work collaboratively and effectively as part of a team.
• Highly organized and detail-oriented, with strong analytical, problem-solving, and critical-thinking abilities.
• Excellent verbal and written communication skills, including the ability to communicate professionally with patients, insurance representatives, coworkers, and leadership.
• Ability to manage multiple priorities, meet deadlines, and perform effectively in a fast-paced environment while maintaining accuracy and quality standards.

Guidelines:

Requires that the incumbent relies on specialized training and/or equivalent experience and performs duties in accordance with Washington Administrative Codes, Federal regulations governing the confidentiality of patient files, and Lifeline Connections Policy and Procedure Manual.

Personal Contacts:

Contacts are with the members of the treatment team, consumers, significant others of the consumers, representatives of various community agencies specializing in the treatment of chemical abuse and mental illness, and related community representatives including lawyers. All personal contacts are carried out in accordance with federal and state laws dealing with the confidentiality of patient records.

Physical Demands:

While performing the essential functions of the job, the employee is regularly required to sit, speak clearly, hear and use hands and fingers to manipulate writing utensils and keys on a keyboard.

Working Environment:

Working hours are remote with potential for occasional in office or other meeting rooms. Participation in staff retreats and staff development activities will be required.

Salary: $18.89 - 19.41/hr DOE

Application Process: To apply electronically for this position, please click "Apply Now" or visit our ADP career center. For more information on this and other positions, please visit our website at

The Benefits: Lifeline Connections strives to be an employer of choice by offering regular and full-time employees a robust and highly competitive benefits package designed to support both personal and family well-being. Our comprehensive benefits include multiple options for medical, dental, and vision coverage for employees and their eligible dependents. In addition, Lifeline Connections provides employer-paid Short Term Disability, Long Term Disability, and Life Insurance, along with access to supplemental coverage options. Full-time employees and eligible part-time employees may also enroll in our 401(k) retirement plan, helping support long-term financial wellness. Beyond benefits coverage, Lifeline Connections is proud to offer generous paid time off. Both full-time and part-time employees earn PTO at competitive accrual rates that increase with years of service, allowing for meaningful time away from work. Employees also receive paid holidays and personal holidays, reinforcing our commitment to work-life balance and employee well-being.