The Healthcare Call Center Agent serves as the primary and compassionate point of contact for patients, providers, and other healthcare stakeholders. This role is crucial for delivering efficient, empathetic, and compliant service within the healthcare system. The agent will handle a high volume of inbound and/or outbound calls and communications related to scheduling, insurance, billing, and general inquiries, strictly adhering to patient privacy regulations like HIPAA.

Key Responsibilities

• Appointment Management: Schedule, reschedule, and cancel patient appointments across multiple specialties, ensuring accuracy and optimizing provider schedules.
• Patient Inquiries: Respond to a high volume of complex patient and provider inquiries regarding services, medical procedures, office policies, and general healthcare information.
• Insurance & Billing:
• Verify patient insurance eligibility, coverage, and benefits prior to appointments.
• Provide information and explanation regarding co-pays, deductibles, account balances, and payment options.
• Assist with pre-authorization processes for procedures or services when necessary.
• Medical Communication: Accurately send and receive messages to and from clinical staff (nurses, physicians, etc.) regarding patient needs, prescription refills, and follow-up care.
• Documentation & Compliance:
• Meticulously document all patient interactions, inquiries, and transactions in the Electronic Health Record (EHR) and/or Customer Relationship Management (CRM) system.
• Strictly adhere to all HIPAA, patient privacy, and data security regulations to protect Protected Health Information (PHI).
• Issue Resolution: Professionally and empathetically handle patient complaints and escalated concerns, working to achieve first-call resolution where possible and escalating complex clinical or billing issues to the appropriate department.
• Performance Goals: Consistently meet or exceed individual and team performance metrics, including call volume, average handle time (AHT), and patient satisfaction (CSAT) scores.
• Outbound Communication: Perform follow-up calls such as appointment reminders, wellness checks, or patient surveys.