Inbound Call Center Representative

We are seeking a detail-oriented and customer-focused Inbound Call Center Representative to join our Revenue Cycle Management team. In this role, you will serve as the first point of contact for patients, guarantors, and insurance carriers, addressing inquiries related to account balances, billing statements, and payment concerns. The ideal candidate will possess strong communication skills, a basic understanding of medical billing processes, and a passion for delivering exceptional service while adhering to HIPAA and company policies. This position offers an opportunity to contribute to efficient revenue cycle operations in a dynamic healthcare environment.

Key Responsibilities

• Answer incoming calls from patients, guarantors, and insurance carriers regarding account balances, statements, and billing concerns.
• Review and interpret Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), and patient account activity to assist in resolving inquiries.
• Educate patients on insurance coverage, co-pays, deductibles, and patient responsibility based on EOB details.
• Demonstrate a basic understanding of the revenue cycle process, including charge capture, claim submission, payment posting, and follow-up.
• Resolve questions related to denials, underpayments, and coordination of benefits, escalating complex issues as appropriate.
• Access and navigate patient billing systems and practice management platforms to research and resolve account discrepancies.
• Maintain accurate documentation of all interactions within the patient record or call tracking system.
• Follow all HIPAA guidelines and company policies to ensure confidentiality and compliance.
• Meet established performance metrics, including call handling time, resolution rate, and customer satisfaction.
• Collaborate with other RCM departments (e.g., coding, collections, eligibility verification) to ensure timely and accurate issue resolution.
• Participate in regular training and quality assurance reviews to maintain up-to-date knowledge of billing practices and payer policies.

Qualifications and Requirements

• High school diploma or equivalent; associate's degree in healthcare administration, business, or a related field preferred.
• Minimum of 1-2 years of experience in customer service, preferably in a call center or healthcare billing environment.
• Basic knowledge of medical terminology, insurance billing, and revenue cycle processes.
• Proficiency in using computer systems, including Microsoft Office Suite and electronic health record (EHR) or practice management software (e.g., Epic, AllScripts/Veradigm, Cerner, or similar).
• Excellent verbal and written communication skills with the ability to explain complex billing information clearly and empathetically.
• Strong problem-solving abilities and attention to detail.
• Ability to handle a high volume of calls while maintaining composure and professionalism.
• Familiarity with HIPAA regulations and commitment to patient confidentiality.
• Availability to work standard business hours (e.g., Monday-Friday, 8 AM-5 PM), with potential for occasional overtime.

Preferred Skills

• Certification in medical billing or coding (e.g., CPC, CPB).
• Experience with payer-specific policies and denial management.
• Bilingual abilities (e.g., English/Spanish) to assist diverse patient populations.
• Strong interpersonal skills for effective collaboration with internal teams.

Key Physical & Mental Requirements:

• Ability to lift up to 50 pounds.
• Ability to push or pull heavy objects using up to 50 pounds of force.
• Ability to sit or stand for extended periods during training sessions or on-site support.
• Ability to use fine motor skills to operate office equipment and/or machinery.
• Ability to receive and comprehend instructions verbally and/or in writing.
• Ability to apply logical reasoning for simple and complex problem-solving.
• Ability to travel to multiple locations as required to support business needs.

What We Offer

• Competitive salary and benefits package, including health insurance, retirement plans, paid time off, and professional development opportunities.
• A collaborative and inclusive work culture focused on employee well-being.
• Opportunities for advancement within the Revenue Cycle Management department.
• Comprehensive training program to ensure success in the role.

Southeast Primary Care Partners is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected class.

How to Apply

Interested candidates should submit a resume and cover letter to https://mysemg.com/careers. Applications will be reviewed on a rolling basis. We thank all applicants for their interest; however, only those selected for an interview will be contacted.