Patient & Insurance Account Resolution Specialist

REVCO SOLUTIONS•Durham, NC

9d•Hybrid

About The Position

Join Our High-Energy Healthcare Call Center Team! At Revco Solutions we provide exceptional customer service to the patients we service. As a leading healthcare call center, we are seeking highly motivated individuals to join our high-energy call center team. If you are passionate about helping others, thrive in a fast-paced environment, and are committed to delivering outstanding customer service, we want you to be part of our team! As a Patient Account Specialist, you will play a vital role in assisting the patients we serve by ensuring they receive the support and guidance they need. You will assist the patient with understanding their account and then work with the patient on resolving their balance. Revco has a performance-based incentive plan, that includes a monthly bonus, as well as a hybrid in office/work from home opportunity.

Requirements

High school diploma or equivalent.
Proficient in basic computer applications and the ability to learn new software quickly.
Empathy, compassion, and a genuine desire to help others.
Strong attention to detail.

Nice To Haves

Excellent communication skills, both verbal and written, with a compassionate and patient-centered approach.
Strong problem-solving skills and the ability to handle challenging situations with empathy and professionalism.
Ability to multitask, navigate computer systems efficiently, and type accurately.

Responsibilities

Answering inbound calls from patients and addressing any inquiries, concerns, or requests with empathy and professionalism.
Assisting patients with insurance inquiries, claims, and billing matters.
Providing information about medical procedures, services, and general healthcare inquiries.
Documenting patient interactions and updating relevant systems according to established guidelines.
Conduct detailed analysis and follow-up on outstanding government insurance claims to support timely and accurate resolution in accordance with payer guidelines.
Communicate with insurance carriers, patients, and other appropriate parties to investigate and resolve outstanding accounts.
Research and resolve claim denials, rejections, underpayments, and payment delays.
Initiate appropriate billing corrections, appeals, resubmissions, and follow-up activities.
Prepare and submit required claim documentation, which may include EOBs, itemized statements, medical records, and other supporting documentation.
Respond to payer and patient inquiries regarding outstanding or delinquent claims.
Utilize payer portals, Electronic Health Records (EHR), patient accounting systems, and other available technology to investigate claim status and manage follow-up activities.
Accurately document account activity, communications, claim status, follow-up actions, and resolutions.
Identify billing or claim issues requiring corrective action or escalation.
Recognize trends in denials, underpayments, or payment delays and communicate findings that may support process improvements.
Maintain compliance with privacy requirements, payer guidelines, government requirements, client requirements, and company policies.
Organize and prioritize daily account inventory in a fast-paced, high-volume environment.
Consistently meet or exceed established productivity, quality, documentation, and account-resolution standards.
Participate in special projects and additional assignments as requested by management.