RCM - Patient Billing Specialist

Forward Health LLC•Draper, UT

2d•$20 - $25•Onsite

About The Position

The RCM Patient Communications Specialist is responsible for handling escalated patient billing scenarios as well as proactively reaching out to patients to provide updates on their billing inquiries. This role serves patients receiving evaluation and management (E&M) and DME services related to sleep apnea care, including but not limited to office visits, sleep studies, and ongoing supply orders. The Specialist must understand how care delivery and order fulfillment connect to the charges patients see on their statements, communicate that clearly and calmly to patients, and coordinate with other teams as needed to ensure billing aligns with the patient's actual course of care. This role also supports the RCM team by working directly with insurance payers to resolve and overturn claim denials so patient claims are paid appropriately.

Requirements

High school diploma or equivalent
1+ years of experience in medical billing, patient collections, or healthcare customer service
Strong verbal communication and conflict-resolution skills
Ability to explain complex billing information in a clear, patient-friendly manner
Comfortable working with insurance payers on denials and appeals
Ability to manage and resolve escalated cases in a timely, organized manner
Must be able to work on-site in Draper, UT

Nice To Haves

Associate's degree preferred
Experience with Salesforce, NikoHealth, and athenaOne (Athena)
Experience with other EMR/practice management platforms
Experience in sleep medicine or DME billing

Responsibilities

Handle escalated patient billing scenarios, as well as outbound outreach to patients to provide updates on the status of their billing inquiries
Return patient calls regarding balances, statements, and billing disputes, and work to resolve them in a timely manner consistent with company expectations
De-escalate frustrated or confused patients by listening actively and responding with empathy
Explain charges, insurance adjustments, and balances in plain, easy-to-understand language, including how services and supply orders factor into a patient's total balance
Collect patient cost share (e.g., copays, coinsurance, deductibles) associated with their claims
Document all patient interactions and resolutions accurately in the appropriate system(s)
Identify recurring issues or trends in inquiries and report them to leadership
Work with other internal teams as needed to verify that billed charges correctly reflect services rendered and orders fulfilled
Investigate discrepancies between a patient's account history and their billed balance before contacting the patient
Escalate any underlying operational issues contributing to billing discrepancies to the appropriate team
Contact insurance companies to research and resolve claim denials
Prepare and submit appeals to overturn denials so patient claims are paid appropriately
Coordinate with billing and coding teams to gather documentation needed for appeals
Track denial and appeal status to ensure timely follow-up and resolution