Customer Service Representative

Review, process, and adjudicate insurance claims in accordance with policy terms and healthcare regulations. Verify patient or member eligibility and coverage for medical, dental, or other healthcare services. Communicate clearly with patients, providers, and insurers regarding the status of claims, benefits, and required documentation. Resolve discrepancies or issues in claims, including denials, billing errors, or coverage disputes.

Supervise and support a multidisciplinary team to deliver safe, compassionate, and effective healthcare services. Collaborate with senior management to implement service improvements and meet strategic goals. Maintain accurate records, including incident reports, audits, and staff appraisals.

Regulates how Protected Health Information (PHI) is used and disclosed. Gives patients rights over their health information Applies to all forms of PHI: oral, written, or electronic.

A Claims and Benefits Representative processes insurance claims, verifies coverage, and assists patients or members in understanding their benefits. They work closely with insurance providers and healthcare teams to ensure accurate, timely payment and resolve any claim issues or denials.

Prepare and submit accurate medical claims to insurance companies, including Medicare and Medicaid. Review patient treatment records and assign appropriate CPT, ICD-10, and HCPCS codes in coordination with medical coders. Verify patient insurance coverage and eligibility prior to services being rendered. Resolve claim issues including denials, rejections, and underpayments through appeals or corrections. Ensure compliance with insurance company guidelines and healthcare regulations. Post payments and adjustments to patient accounts and reconcile discrepancies. Generate and send patient statements for co-pays, deductibles, or non-covered services. Communicate with patients, insurance companies, and healthcare providers regarding billing inquiries and account status. Maintain detailed records of billing activities, payments, and correspondence. Stay updated with changes in billing regulations, coding updates, and payer requirements.

Prepare and submit accurate medical claims to insurance companies, including Medicare and Medicaid. Review patient treatment records and assign appropriate CPT, ICD-10, and HCPCS codes in coordination with medical coders. Verify patient insurance coverage and eligibility prior to services being rendered. Resolve claim issues including denials, rejections, and underpayments through appeals or corrections. Ensure compliance with insurance company guidelines and healthcare regulations. Post payments and adjustments to patient accounts and reconcile discrepancies. Generate and send patient statements for co-pays, deductibles, or non-covered services. Communicate with patients, insurance companies, and healthcare providers regarding billing inquiries and account status. Maintain detailed records of billing activities, payments, and correspondence. Stay updated with changes in billing regulations, coding updates, and payer requirements.