Patient Financial Services Specialist (California, Nevada, Arizona)

Patient Financial Services Specialist Reports to: Patient Financial Services Manager Status: Full-time, Mon-Fri The Patient Financial Services Specialist supports the organization’s mission of delivering high-quality care and service by managing patient financial inquiries and the accounts receivable lifecycle following insurance adjudication. This is a high‑call‑volume, patient customer service position focused on resolving complex billing questions, improving patient understanding of benefits and balances, and facilitating timely payment resolution. Essential Duties Patient Financial Services Operations Proactively contact patients with outstanding balances to review payment options, clarify insurance benefits, address complex billing inquiries, resolve payment processing issues, and maintain service level agreements in response time. Provide prompt, efficient, detailed, patient-oriented service while managing a high volume of inbound and outbound calls. Optimize patient account collections by performing timely follow‑up on outstanding balances and analyzing payer correspondence (EOBs/ERAs) to verify accurate processing and identify any necessary follow-up actions. Review and reconcile patient and insurance balances for accuracy, ensuring accounts reflect correct responsibility, verifying proper payment posting, and allocating patient payments as needed to maintain accurate account activity. Contact patients when payments cannot be processed (such as returned checks and expired or declined credit cards) to review the issue, provide resolution options, and clarify account expectations. Address or defend disputed patient payments to ensure accurate and timely account resolution. Prepare and process accounts for transition to third‑party collections in alignment with organizational workflows, documentation standards, and regulatory requirements to maintain accuracy and compliance. Manage the patient statement process by ensuring bills are generated and sent timely, efficiently, and accurately when requested and/or according to established workflows. Provide itemized statements, receipts, and supporting documentation promptly upon request. Monitor and manage incoming emails, task queues, and other assigned requests to ensure timely follow-up and accurate completion of patient and account related inquiries. Other duties as assigned. Patient Experience & Advocacy Identify and assess potential patient A/R and billing challenges, recommend upstream improvements, and support leadership in implementing solutions that drive timely resolution. Support team growth and collaboration by participating in 1:1 meetings, team huddles, and engaging in collective problem‑solving to improve workflows and patient experience. Work collaboratively with RCM staff, operational and clinical departments, and external vendor partners to drive efficient and accurate account resolution. Compliance & Regulatory Oversight Maintain current understanding of insurance regulations alongside federal and state guidance related to patient billing and communication practices, ensuring full compliance with industry and regulatory standards. Adhere to HIPAA privacy and security standards by protecting all patient health information and ensuring it is accessed, used, and shared only in compliance with regulatory requirements. Escalate issues timely and appropriately to the Patient Financial Services Manager and/or other senior leaders. Technology & Systems Master the technology suite used in daily work, including Microsoft Office (Excel, Word, Outlook), ModMed/EMA, Zoom, and Klara, to collaborate with teams and support patients effectively. Document all interactions, research, and follow‑up actions thoroughly and professionally in the EHR/PM system and related tools ensuring adherence to company documentation standards and timely closure of pending issues. Required Skills/Abilities Comprehensive knowledge of U.S. healthcare revenue cycle functions, including insurance plan structures, patient liability determination, coordination of benefits, payer rules, claim adjudication, and denial trends. Comprehensive knowledge of HIPAA privacy and security regulations and the ability to follow all organizational requirements for safeguarding protected health information in a remote work environment. Excellent customer service and conflict resolution skills, with the ability to diffuse complex and confrontational situations. Strong written and verbal communication skills, with the ability to manage sensitive conversations professionally and accurately. Ability to educate patients on explanation of benefits for insurance processed claims. Ability to communicate effectively with peers, patients, external vendors, and insurance companies. Ability to prioritize and organize tasks at hand in a fully remote environment with minimal supervision. Ability to adhere to company policies, exercise sound judgment, manage stress effectively, and work safely and respectfully with others. Ability to work independently and manage time appropriately in a fully remote environment. Ability to meet productivity and quality measurement requirements. Ability to work the required business hours to support organizational and patient care needs, including aligning with PST and MST time zones as necessary. Demonstrate understanding of key federal and state regulatory requirements. Advanced Microsoft Office (Outlook, Word, Excel) skills. Experience with the EHR/PM system Modernizing Medicine/EMA is a plus. Knowledge of California specific payer requirements, including Medi‑Cal Managed Care plans and IPA networks, is a plus. Dermatology experience is a plus. Bilingual communication skills are strongly preferred. Education & Experience 2+ years of customer service experience in a healthcare call center or high-volume patient support environment (inbound/outbound). 2+ years of experience in medical billing, insurance claims, or healthcare revenue cycle functions. 1+ years of remote working experience required. Must have a high school diploma or equivalent educational experience. Associate degree is highly preferred. Proficiency in Microsoft Office with advanced Excel skills. #J-18808-Ljbffr Skin-and-Cancer-Institute