Customer Solutions Representative

St. Luke's Cataract & Laser Institute • Tarpon Springs, FL

3d • Onsite

About The Position

The Customer Solutions Representative reporting to the Revenue Cycle Manager is responsible for taking inbound calls to answer patient’s question about their medical bills. The ideal candidate will be comfortable in working in a team environment and has a strong customer service focus to effectively interact with patients, doctors, staff and management.

Requirements

• Solid understanding of medical insurance including deductibles, copay and coinsurance is highly preferred
• Experience with verifying and interrupting medical befits for Medicare, Medicaid and major commercial health insurance and secondary payers required
• Experience processing provider referrals and prior authorization requests
• Understanding of medical terminology and ICD-10 codes and Diagnosis
• Familiar with individual payer guidelines and authorization/referral requirements based on insurance plans and if needed communicate with insurance companies via phone and/or website to provide any supporting clinical documentation needed to complete the authorization process
• Ensure complete and accurate information maintained in patient account including authorization or referral received from payer or Primary Care Physician
• Strong people skills required; diplomatic, patient, flexible and able to multi-task and be cross trained on all functions within the Insurance Verification Department
• Must be mobile in an office setting, sitting, standing, walking, and bending
• Perform general duties and other functions as required or assigned
• Working knowledge of Microsoft Suite including Excel, Word, Outlook

Responsibilities

• Respond to inbound calls, emails, and messages from patients, insurance carriers, and providers regarding insurance billing and claim issues
• Provide clear and accurate information regarding claim status, benefit coverage, balances, co-pays, deductibles, and authorization requirements
• Resolve or escalate customer concerns involving insurance denials, coordination of benefits (COB), and payment disputes
• Investigate account balances by reviewing EOBs, remittance advices, claim notes, and insurance policies
• Contact insurance carriers as needed to verify claim receipt, payment status, or denial reasons
• Work with internal billing and coding staff to resolve discrepancies and ensure appropriate follow-up on claims
• Document all customer interactions and actions taken within the billing system or CRM
• Track open issues and ensure timely follow-up and closure of outstanding inquiries
• Assist in preparing letters or forms required for appeals, corrected claims, or additional documentation requests
• Educate patients on insurance terminology, claim processes, and their financial responsibilities
• Explain payment options, including setting up payment plans or connecting them with financial counseling services
• Help patients understand coordination of benefits, prior authorization requirements, and out-of-network implications

Benefits

• Medical, Dental, Vision, Life Insurance, 401(k) with Employer Match, Paid Time Off, and Holiday Pay
• The chance to work with and learn from excellent doctors and staff
• Career Advancement opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 251-500 employees