Customer Relations Representative

Job Summary: Receives and services telephone and walk-in inquiries. Maintains patient/guarantor and insurance information on systems. Acts as representative for organization. Researches and resolves account inquiries. Maintains current knowledge of Kaiser health plan benefits and policies, and government programs and commercial insurances billing requirements. Essential Responsibilities: * Receives and responds to inquiries from patients, insurance carriers, employers, staff and external agencies. Obtains and documents necessary information. Answers questions and resolves billing issues. * Greets, assists, and responds to customers. Utilizes telephone equipment and/or tools to ensure adequate handling of phone calls. Ensures adequate phone coverage to support volume of incoming telephone calls. * Receives and receipts payments received for receivables and forwards to data entry to prepare bank deposit and cash jacket. * Gathers and enters pertinent account information. Completes account reconciliation, correct billings and/or payment allocations. Documents accurate and complete account notes in tracking system for all account activity. * Researches documents and all other available sources to determine validity of refunds, adjustment or write-offs. Prepares refunds, adjustment and write-off requests. Submits request to data entry to process. * Manages credit balance report and insures credits allocations and refunds are resolved within standards. * Tracks and validates co-pay maximum requests. Coordinates with claims as necessary and issues co-pay max cards and reports. * Maintains open communication with patients, insurance carriers, external agencies, and staff to assure proper and adequate exchange/interpretation of data and information. * Performs other duties and accepts responsibility as assigned.

Created: 2025-11-06