Lead Patient Service Specialist

The Lead Patient Service Specialist provides customer service via telephone, answering calls with professionalism and addressing patient needs efficiently. This role serves as a key liaison between callers and all company locations, responsible for collecting demographics, insurance details, and responding to billing inquiries. Responsibilities include high patient interaction, coordination of insurance documentation, accurate billing, claim submission and tracking, handling denials, and managing payments. The position requires leadership, critical thinking, and deep knowledge of Medicare, Medicaid, and commercial insurance to support team training and maximize billing system efficiency.

Essential Duties and Responsibilities:

Performs job in accordance with Company mission, vision and goals. Reviews and resolves complex issues that result in payer denials, including appeals, coding corrections, medically necessity rules and other related functions. Contacts Provider Service Representatives to resolve repetitive payment and/or denial issues. Acts as a resource and supports the Billing Staff for complex issues. Provides professional and courteous customer/patient care, displaying knowledge of the treatment approach; displayed through professional phone etiquette. Ensures first call resolution for all applicable calls. Escalates/routes appropriate calls/tasks to proper recipient(s) for resolution. Conducts outbound calls, as needed. Communicates electronically with patients/customers via online portal or other Company communication methods. Trains and onboards new Patient Service Representatives. Assists management in ensuring accurate and timely patient flow by other Patient Service Specialists. Acts and a liaison between management and staff. Performs quality assurance audits for the Patient Service Specialists. This may include listening to calls, assisting in developing quality improvement plans, and providing feedback to staff. Assists staff with escalation calls. Analyzes and resolves billing issues. Answers billing questions and inquiries from patients and internal staff. Updates patient files with address changes, contact information changes, etc., as needed. Relays updates regarding process and/or policy changes to team members and leadership when identified. Efficiently navigates assigned insurance companies' proprietary websites to find policies, research payments, etc. Keeps supervisor apprised of matters regarding accounts receivable. Responds to requests from the billing call center team in a timely fashion. Researches denials and submits correct claims/medical documentation. Reviews and manages claims within the work dashboard hold buckets for resolution. Manages team projects and assists with process implementation, as directed. Exercises confidentiality in all areas, abiding by HIPAA rules and regulations. Checks and responds to work e-mail on a regular basis throughout the workday. Participates in and complete all required trainings and in-services. Performs other duties as assigned. Minimum Qualifications:

High School Diploma, or equivalent WITH a minimum of five (5) years related experience with demonstrated increasing responsibility; OR an equivalent combination of education and/or experience. Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook). Must have excellent written and oral communication skills, including exceptional customer service. Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public. Must be able to work individually as well as within a team. Must be able to follow both verbal and written instructions. Must be able to work a flexible schedule. Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations. Must be able to multi-task and prioritize. Must demonstrate extreme attention to detail. Must possess strong organization skills. Must be able to problem solve and use reasoning. Must be able to meet predefined quality standards. Must maintain and project a professional attitude and appearance at all time. Must have a working knowledge of CPT and ICD-10 coding rules. Must have a solid foundation of insurance knowledge and guidelines for third party payers. Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology. All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance. Preferred Qualifications:

Five (5) years' experience working with an Electronic Medical Record (EMR). Medical Billing Certification. Driving/Travel:

The employee must have reliable transportation. While the primary workplace may be closest to the employee's home, work assignments could be in any of the Company's locations.

Compensation and Benefits:

Pay Range:

$25.00/Hr - $27.00/Hr PTO:

Up to 96 hours in first year (pro-rated based on start date) Holidays:

7 (New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day) Retirement:

401(k) with employer match Health Benefits:

Medical (single and family), Dental (single and family), Vision (single and family) Other Company-Paid Benefits:

Short-Term Disability, Long-Term Disability, Basic Life/AD&D, Employee Assistance Program Other Voluntary Benefits:

Voluntary Life, Accident, Critical Illness, Hospital Indemnity