Patient Account Specialist - (Call Center)

Oct 10, 2016
Oct 19, 2016
Employer Type
Direct Employer
Employment Type
Full Time
Responds to patient/financial responsible party calls effectively and provides exemplary customer service. Identify callers' needs; educate them on CareCentrix role in their care. Determines the acceptance of patient's financial responsibility through claim research, plans, eligibility, notes, etc.; goal to resolve patient's account. Identifies and escalates patient issues and concerns to the appropriate senior. Works under general supervision.


Patient Account Specialist

• Researches, resolves, and documents patient inbound and outbound calls involving a wide range of issues utilizing multiple information systems. This includes communications with internal business centers and external customers. Assures customer agreement by summarizing and closing each call appropriately.

• Investigates payment status and determines ultimate patient financial responsibility. Collect outstanding balance, offer patient assistance with financial responsibility through various financial options.

• Identifies overpayments, processes refunds, adjustments, and appeals as necessary. Analyzes and resolves payment variances, which may involve preparation of adjusted and corrected bills, or adjusting accounts receivable entries in accordance with existing operating procedures. This may include the use of special reporting.

• Minimizes patient dissatisfaction by listening attentively, maintaining a professional tone, and acknowledging their concerns. Escalates patient issues and concerns to the appropriate senior.

• Works with internal and external customers to obtain appropriate medical documentation, work orders, proof of delivery, or other documentation necessary to resolve open account issues.

• Reviews payer payment explanation for accuracy of patient responsibility.

• Exercises good judgment, interpret data, and remains knowledgeable in details of all related CareCentrix contracts, policies and procedures. Participates in process improvement initiatives; maintains teamwork, customer service production and quality standards to assure timely, efficient and accurate call resolution.

• Maintain patient confidentiality and data integrity in accordance with Health Information Portability Accountability Act (HIPAA), and company policies and procedures.

• Sends patient necessary documentation required to complete the payment arrangement process. Prepares payment plan agreements or other correspondence; including requests for secondary payers or Medicare/Medicaid verification or other documentation necessary to resolve open account issues. Assures patients return documentation or signed payment agreements.

• Takes appropriate action when patient requests assistance in reconciling their financial responsibility, including proper follow up.

• Participates in special projects and performs other duties as assigned.


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


• Abides by and demonstrates the company Mission - Vision - Values through both behavior and job performance on a day-to-day basis.

• Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.

• Adheres to and participates in Company's mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.


• Must be able to remain in a stationary position 90% of the time.

• Occasionally move about the office to access file cabinets, office machinery, etc.

• Constantly operates a computer and other office productivity machinery (i.e., a calculator, copy machine, and computer printer).

• Frequently communicates via phone and email. Must be able to exchange accurate information in these situations.

• Occasionally lift items weighing up to 10 pounds.

High School Diploma or the equivalent plus a minimum of 2 years medical claims processing and reimbursement experience generally required. Knowledge of healthcare collection procedures and related internal and external software applications are required. Effective analytical, verbal and communication skills also required as well as knowledge of HIPPA, The Fair Credit and Collections Act, HCPC, CPT, ICD-9 coding, intermediate competency of Microsoft Office Applications, and mathematical calculations. Knowledge of Utilization Management and URAC standards. Basic competency of Microsoft office applications and mathematical calculations is required. Must be well organized and possess excellent time management skills.

CareCentrix maintains a drug-free workplace in accordance with Florida's Drug Free Workplace Law.

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