RCM Call Center Representative – Patient Accounts & Collections

• *Description** The Call Center Representative – Patient Accounts & Collections is responsible for managing all aspects of patient accounts receivable (A/R) related to self-pay balances. This role handles inbound and outbound patient calls, collections, payment plans, refunds, and follow-up on clinic-identified balance inquiries. The representative reviews patient accounts within the Practice Management (PM) system, interprets Explanation of Benefits (EOBs), and applies knowledge of major payor policies to accurately explain balances and resolve patient concerns. The position plays a critical role in maintaining patient satisfaction while ensuring timely and compliant collections.

• *Requirements**

Key Responsibilities

• *Patient Account & Collections Management
• Manage assigned patient A/R accounts, including follow-up on outstanding self-pay balances.
• Conduct inbound and outbound calls to patients regarding balances, statements, payment options, and account resolution.
• Collect payments via approved payment methods and accurately post transactions in the PM system.
• Set up, maintain, and monitor compliant payment plans according to organizational policy.
• Process and follow up on patient refunds as needed.
• Perform follow-up on clinic requests related to patient balances, billing questions, or account corrections.
• *Account Review & Billing Accuracy
• Review patient accounts in the PM system to ensure accuracy of charges, payments, adjustments, and insurance processing.
• Read and interpret EOBs to explain insurance determinations, denials, patient responsibility, and payor adjustments.
• Apply knowledge of major payor policies (commercial, Medicare, Medicaid) when addressing patient inquiries.
• Identify billing discrepancies and escalate issues appropriately for resolution.
• *Patient Communication & Service
• Provide clear, empathetic, and professional communication to patients regarding sensitive financial matters.
• Educate patients on billing statements, insurance processing timelines, and financial responsibility.
• Handle escalated or complex patient inquiries related to balance or insurance explanations.
• Maintain detailed and accurate account notes documenting all patient interactions and actions taken.
• *Compliance & Quality
• Ensure all collection activities comply with federal and state regulations (including FDCPA where applicable), organizational policies, and Financial Assistance Program (FAP) guidelines.
• Follow call handling, scripting, and documentation standards to ensure consistency and quality.
• Protect patient confidentiality and adhere to HIPAA requirements at all times.
• *Productivity & Performance
• Meet or exceed individual performance goals related to call volume, collections, payment plans, and account resolution.
• Participate in quality reviews, coaching, and ongoing training.
• Collaborate with team members and supervisors to support workflow efficiency and service level goals.
• Other duties as assigned.
• *Qualifications
• *Required
• High school diploma or equivalent.
• Minimum of 1–2 years of experience in healthcare billing, patient collections, or medical call center environment.
• Experience working patient A/R and self-pay balances.
• Ability to read and understand EOBs and patient billing statements.
• Working knowledge of major payor types and basic payor policies.
• Experience using a Practice Management (PM) system.
• Strong verbal communication, customer service, and conflict-resolution skills.
• Reliable high-speed broadband internet connection required for remote work.
• *Preferred
• Experience in a multi-specialty or clinic-based healthcare setting.
• Knowledge of Financial Assistance Programs (FAP) and payment plan compliance.
• Prior experience handling refunds and account adjustments.
• Experience with RingCentral (VoIP) and Allscripts (PM/EHR) systems is strongly preferred.
• Proficiency with Microsoft Office tools (Outlook, Word, Excel, Teams) preferred.
• *Skills & Competencies
• Strong attention to detail and accuracy
• Empathetic and professional communication style
• Ability to explain complex billing and insurance concepts in simple terms
• Time management and ability to prioritize workload
• Comfort handling sensitive financial conversations
• Proficiency with call center systems and Microsoft Office applications
• *Key Physical & Mental Requirements
• Ability to lift up to 50 pounds.
• Ability to push or pull heavy objects using up to 50 pounds of force.
• Ability t

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