RCM - Patient Billing Specialist

RCM - Patient Billing Specialist
Location: Draper, UT (on-site)

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 inquiries
• Return patient callsregardingbalances, statements, and billing disputes, and work to resolve themin a timely mannerconsistent with company expectations
• De-escalate frustrated or confused patients by listening actively and responding with empathy
• Explain charges, insurance adjustments, and balances in plain, easy-to-understand language, including how services and supply orders factor into a patient's total balance
• Collect patient cost share (e.g., copays, coinsurance, deductibles) associated with their claims
• Document all patient interactions and resolutions accurately in theappropriate system(s)
• Identifyrecurring issues or trends in inquiries and report them to leadership

Cross-Functional Coordination

• Work with other internal teams as needed to verify that billed charges correctly reflect servicesrenderedand orders fulfilled
• Investigate discrepancies between a patient's account history and their billed balance before contacting the patient
• Escalate any underlying operational issues contributing to billing discrepancies to theappropriate team

Payer & Claims Support

• Contact insurance companies to research and resolve claim denials
• Prepare andsubmitappeals to overturn denials so patient claims are paid appropriately
• Coordinate with billing and coding teams to gather documentation needed for appeals
• Track denial and appeal status to ensuretimelyfollow-up and resolution

Qualifications

• High school diploma or equivalent;Associate'sdegree preferred
• 1+ years of experience in medical billing, patient collections, or healthcare customer service
• Strong verbal communication and conflict-resolution skills
• Ability to explain complex billing information in a clear, patient-friendly manner
• Comfortable working with insurance payers on denials and appeals
• Ability to manage and resolve escalated cases ina timely, organized manner
• Must be able to work on-site in Draper, UT

Preferred

• Experience with Salesforce,NikoHealth, andathenaOne(Athena)
• Experience with other EMR/practice management platforms
• Experience in sleep medicine or DME billing

Core Competencies

• Empathy and patience under pressure
• Clear, professional communication (verbal and written)

• Cross-team collaboration and investigative problem-solving
• Attention to detail across billing and account data
• Strong time management and prioritization skills