Customer Service Specialist

St. Luke's Health System•Boise, ID

About The Position

The Customer Service Specialist is responsible for resolving self-pay accounts and maintaining strong relationships with patients, guarantors, and business office departments. The role handles incoming and outgoing calls from patients and their representatives, physician offices, and insurance carriers; answers questions; addresses complaints; troubleshoots problems; collects patient balances; and provides related information. The specialist verifies patient identity before disclosing information, assists with updating account details, responds to billing and insurance-processing questions, and uses available resources to resolve inquiries. The role follows scripts, applicable laws and standards including HIPAA, and call-quality and time-management guidelines. Account activity and needed follow-up steps are documented. Under direct supervision, the specialist resolves routine questions and problems and escalates complex issues appropriately. The position may also prepare written responses and collaborate with administrative departments and hospital service areas on account resolution. Ongoing learning and development are encouraged.

Requirements

High school diploma or equivalent.
One year of relevant experience.

Responsibilities

Accept inbound calls from patients, physician offices, insurance carriers, and others, often within a specified response-to-call timeframe, to collect self-pay balances and resolve concerns promptly.
Make outbound calls to patients, physician offices, insurance carriers, and others as needed.
Follow applicable laws, regulations, and industry standards, including HIPAA guidelines.
Verify each patient before disclosing information and help update account information such as phone number, address, or email address.
Maintain and improve quality results by following guidelines, call metrics, and time-management standards.
Follow provided scripts to facilitate consistent and expedient account resolution.
Respond promptly to patient inquiries about billing procedures, policies, and statements.
Use multiple resources to resolve patient inquiries while on the phone.
Document patient account activities concisely, including future steps needed for resolution.
Resolve routine questions and problems under direct supervision and escalate more complex issues appropriately.
Prepare written responses to patients and customers regarding account resolution as needed.
Work effectively with administrative departments and hospital service areas to facilitate patient account resolution.
Explain how insurance claims were processed using appropriate terminology that is understandable to patients.
Engage in continuous learning and development, including training, mentorship, and leadership development.
Perform other duties as assigned.