Medical Billing Representative

Job Summary:

The Medical Billing Customer Service Representative is responsible for handling patient inquiries and resolving billing issues, processing payments, and communicating with insurance companies to ensure accurate and timely billing. This role requires an understanding of medical insurance policies, billing codes, and healthcare procedures, alongside exceptional customer service skills.

Key Responsibilities:

• Customer Service: Answer incoming calls and emails from patients, insurance companies, and healthcare providers regarding medical billing inquiries, including account status, charges, and payment issues.

• Billing and Payment Processing: Assist patients with understanding their medical bills, reviewing their insurance coverage, and resolving discrepancies. Process payments, refunds, and adjustments as needed.

• Insurance Verification and Claims: Work with insurance companies to verify patient coverage, confirm claims, and resolve denied or underpaid claims.

• Account Resolution: Follow up on overdue accounts, provide patients with payment plans, and resolve disputes efficiently. Ensure that all payments are posted correctly and accurately.

• Data Entry and Documentation: Enter billing information accurately into the system and maintain updated records. Ensure all interactions and resolutions are properly documented.

• Compliance: Adhere to all privacy laws and billing regulations, including HIPAA, and ensure that all information is handled confidentially and ethically.

• Communication with Providers: Liaise between patients, healthcare providers, and insurance companies to ensure accurate billing information is processed.

• Problem Solving: Investigate and resolve billing discrepancies, ensuring that billing statements are correct and that issues are handled in a timely and professional manner.

• Patient Education: Provide patients with clear and accurate explanations regarding billing statements, insurance claims, co-pays, and out-of-pocket costs.

Qualifications:

• High school diploma or equivalent; additional certifications in medical billing or coding is a plus.

• Proven experience in medical billing, customer service, or related healthcare fields.

• Strong understanding of medical terminology, insurance policies, and coding procedures.

• Familiarity with billing software and electronic health records (EHR) systems.

• Excellent written and verbal communication skills.

• Strong problem-solving skills and the ability to work in a fast-paced environment.

• Attention to detail and accuracy in managing billing accounts and resolving issues.

• Ability to work independently and as part of a team.

• Professional demeanor and the ability to handle sensitive and confidential information.

• Ability to handle difficult conversations or escalated situations with patience and empathy.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.