SUMMARY OF POSITION

The Patient Contact Specialist is responsible for engaging patients, families, and authorized representatives to obtain critical information needed to resolve claims. This role supports the collections process by completing coordination of benefits, securing required documentation, and addressing patient-related questions that impact claim resolution. The specialist works assigned queues, follows documented direction, and uses Apollo PFS patient contact SOPs to gather accurate and complete information. Once complete, the account is reassigned for further processing

ESSENTIAL JOB DUTIES

• Contact patients, family members, estates, or authorized representatives (including power of attorney) to obtain required information. 
• Complete coordination of benefits (COB) to ensure accurate payer sequencing. 
• Obtain and secure required documentation, including Designation of Representative (DOR) forms for appeals. 
• Address patient questions and provide clear, professional communication to support claim resolution. 
• Follow all compliance and privacy requirements when handling patient information. 
• Work assigned queues daily, following notes and direction provided on each account. 
• Review account documentation and understand the requested action prior to outreach. 
• Use Apollo PFS patient contact SOPs to guide all interactions and processes. 
• Accurately document all communication, outcomes, and next steps in the system. 
• Reassign accounts back to the appropriate team member once required information is obtained. 
• Ensure all information collected is complete, accurate, and supports claim processing. 
• Identify missing or conflicting information and take appropriate action to resolve. 
• Maintain high standards of professionalism and customer service in all interactions. 
• Collaborate with collectors, supervisors, and other team members to support claim resolution. 
• Communicate clearly regarding account status, challenges, or additional needs. 
• Adapt to changing priorities, processes, and responsibilities as needed. 
• Assigned queues are worked consistently and timely. 
• Required information (COB, DOR, and other documentation) is obtained accurately and efficiently. 
• Accounts are returned ready for processing with minimal rework. 
• High-quality documentation and clear notes are maintained on every account. 
• Positive, professional interactions with patients and representatives. 
• Strong alignment with team workflows and responsiveness to direction. 
• Contribution to overall reduction in delays caused by missing patient information. 
• Other duties as assigned.

MINIMUM REQUIRED QUALIFICATIONS

• High school diploma or GED.
• 1-2 years in customer service.
• Strong communication skills.
• Basic computer skills (data entry, systems, Microsoft office).
• Ability to multitask and work in a fast-paced environment.
• Good customer service.
• Regular and reliable attendance.

PREFERRED QUALIFICATIONS

• Understanding of medical terminology.
• Previous experience in healthcare, medical office, or call center environment.
• Bilingual (English/Spanish) Preferred.
• Experience with data entry and processing in high-volume environments.
• Knowledge of insurance authorization and pre-authorization processes in a healthcare setting

WORKING CONDITIONS/ENVIRONMENT 

• Inside, office environment.
• The majority of the workday is spent sitting at a desk or workstation while performing tasks on a computer, such as data entry, email communication, and documentation. Should be comfortable with prolonged periods of sitting.
• The ability to type and use a keyboard extensively. Proficiency in typing and computer skills are essential for this role.
• Frequently engage in verbal and written communication with employee management and external parties. Clear and effective communication skills are essential.
• Must be able to lift 10 pounds at times. Occasionally need to handle files, paperwork, or office supplies, which could involve lifting light objects.
• Must be able to read documents, computer screens, and other materials.
• Must be able to access and navigate each department at the organization’s facilities.
• Ability to travel and work a flexible schedule when needed (evening/weekends).