RCM - Patient Billing Specialist

Department: Revenue Cycle Management

Reports To: RCM Supervisor / Billing Manager

Position Summary

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.

Key Responsibilities

Escalated Patient Communication

Handle escalated patient billing scenarios, as well as outbound outreach to patients to provide updates on the status of their billing inquiriesReturn patient callsregardingbalances, statements, and billing disputes, and work to resolve themin a timely mannerconsistent with company expectationsDe-escalate frustrated or confused patients by listening actively and responding with empathyExplain charges, insurance adjustments, and balances in plain, easy-to-understand language, including how services and supply orders factor into a patient's total balanceCollect patient cost share (e.g., copays, coinsurance, deductibles) associated with their claimsDocument all patient interactions and resolutions accurately in theappropriate system(s)Identifyrecurring issues or trends in inquiries and report them to leadershipCross-Functional Coordination

Work with other internal teams as needed to verify that billed charges correctly reflect servicesrenderedand orders fulfilledInvestigate discrepancies between a patient's account history and their billed balance before contacting the patientEscalate any underlying operational issues contributing to billing discrepancies to theappropriate teamPayer & Claims Support

Required

High school diploma or equivalent;Associate'sdegree preferred1+ years of experience in medical billing, patient collections, or healthcare customer serviceStrong verbal communication and conflict-resolution skillsAbility to explain complex billing information in a clear, patient-friendly mannerComfortable working with insurance payers on denials and appealsAbility to manage and resolve escalated cases ina timely, organized mannerMust be able to work on-site in Draper, UTPreferred

Experience with Salesforce,NikoHealth, andathenaOne(Athena)Experience with other EMR/practice management platformsExperience in sleep medicine or DME billingCore Competencies

Empathy and patience under pressureClear, professional communication (verbal and written)