The Medical Billing Customer Service Representative (CSR) is the primary point of contact for patients and/or insurance carriers regarding medical billing, account balances, and claims status. This role combines exceptional customer service skills with a specialized knowledge of the revenue cycle, insurance practices, and compliance regulations to resolve financial inquiries and ensure a positive patient experience.

Key Responsibilities and Duties

• Billing Inquiries & Resolution: Answer a high volume of inbound and outbound calls, emails, and online inquiries from patients regarding their medical bills, co-pays, deductibles, and account balances.
• Claims Status: Research and clearly communicate the status of insurance claims, explaining what was paid, denied, or pending based on Explanation of Benefits (EOBs) and payer communication.
• Account Explanation: Review patient accounts, explain complex charges, and translate medical billing codes (CPT, ICD-10) and insurance jargon into clear, understandable language for the patient.
• Payment Processing: Process patient payments, establish and manage payment plans for outstanding balances, and discuss financial assistance options as necessary.
• Issue Escalation: Identify and escalate complex billing discrepancies, coding errors, or persistent insurance issues to the dedicated Medical Biller, Coder, or A/R follow-up team for correction.
• Insurance Verification: Collect and verify patient insurance information and benefits as needed to address billing questions and ensure proper claim submission.
• Documentation & Compliance: Maintain detailed, accurate, and timely records of all customer interactions, payments, and actions taken in the billing and EHR systems. Adhere strictly to HIPAA guidelines and all company confidentiality protocols.