RCM/Patient Services Specialist

Duties and Responsibilities

• Monitor patient accounts aging reports to identify and follow up on overdue balances.
• Answer patient phone calls and inquiries regarding billing statements, balances, and payment options.
• Establish, document, and maintain payment plans and outside financing options when appropriate.
• Ensure timely posting and reconciliation of patient payments, copays, deductibles, and credits in partnership with practice payment posting specialists.
• Review statement cycles to ensure timely and accurate patient billing.
• Work through and resolve any patient-related escalations as related to offshore vendors, to include but not limited to Collectly and Promptly, in a timely manner.
• Identify and investigate credit balances, separating true credits from false credits, and process refunds in compliance with company policy.
• Collaborate with Accounts Payable on refund processing and documentation.
• Prepare and distribute aging and balance logs to appropriate stakeholders as requested.
• Maintain a detailed audit trail of all account activity in the Practice Management (PM) system.
• Escalate unresolved or disputed patient balances to management as appropriate.
• Evaluate past-due accounts to determine next steps that may result in transferring to an external collection agency.

Education, Licensure & Certification Requirements

• A High School Diploma or GED.

Experience Requirements

• Minimum: 1+ years of experience in medical billing, patient collections, or related healthcare revenue cycle functions.
• Experience in Optometry/Ophthalmology practice environment preferred.

Knowledge, Skills and Abilities Requirements

• Ability to type and enter data with proficiency and accuracy.
• Knowledge of medical billing procedures, insurance processes, and patient collections.
• Understanding of credit balance and refund protocols.
• Strong communication, negotiation, and problem-solving skills.
• Ability to provide patient-centered customer service with professionalism and empathy.
• Professional in appearance and actions.
• Detail-oriented, organized, and able to manage multiple priorities.
• Mets attendance and tardiness expectations.
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations.
• Interpersonal skills to support customer service, functional, and teammate support needs.
• Able to communicate effectively in English, both verbally and in writing.
• Intermediate computer operation.
• Proficiency with Microsoft Excel, Word, PowerPoint and Outlook.
• Specialty knowledge of systems relating to job function.
• Familiarity with Practice Management systems (e.g., NextGen, Waystar).
• Knowledge of state and federal regulations for this position; general understanding of HIPAA and healthcare regulations.