Self Pay Representative (Administrative)
Title: Self Pay Representative
Reports to: Director, Patient Financial Services
Classification: Individual Contributor
Location: Boston (Hybrid)
Job description revision number and date: V 3.0; 4.28.2025
Organization Summary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices nationally. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.
Job Summary:
We are seeking a detail-oriented Self-Pay Representative with experience in Epic, FQHCs, and Massachusetts healthcare billing regulations. The ideal candidate will have a strong understanding of insurance and accounts receivables, out of pocket expenses and first party liability, experience with call center technology, and a passion for problem solving and customer service. The role will focus on assisting patients with self-pay balances, setting up payment plans, insurance discovery, referring patients for financial assistance, and resolving general account inquiries. This role involves working closely with other internal teams to resolve billing issues and optimize the use of Epic to make sure the self-pay cycle is working efficiently.
Responsibilities:
Manage inbound and outbound calls related to patient self-pay accounts using call center technology
Assist patients with understanding their financial responsibilities and options for payment or financial assistance
Identify accounts eligible for sliding scale adjustments, charity care, or other financial programs based on FQHC guidelines
Set up and maintain payment plans in accordance with organizational policies
Follow up on outstanding balances and work proactively to resolve disputes or escalations
Utilize Epic to review, update, and manage patient accounts accurately
Document all patient interactions and account actions in Epic and other designated systems
Provide high-quality customer service by addressing patient concerns with empathy and professionalism
Collaborate with billing, coding, and financial counseling teams to ensure seamless patient experiences
Use various technologies to identify insurance coverage and update the system accordingly
Work assigned Epic workques including returned mail/bad addresses, statements on hold, and technical items that prevent a statement from being produced
Work with statement vendor as needed to ensure the statement cycles are on time and accurate
Resolve self-pay credit balances, undistributed dollars, and copay/deposit resolution
Provide feedback to leadership on trends and identified issues that so that process changes can be made to promote efficiencies and desired outcome
Stay informed of all applicable federal, state, and organizational policies regarding patient billing and financial assistance
Required Skills:
Knowledgeable of Massachusetts healthcare billing regulations and payer requirements
Good communication skills, detailed orientated, diligent with strong problem-solving skills
Experience working with insurance discovery tools
Knowledge of medical and industry terminology
Experience in Microsoft Office Suite
Strong commitment to quality assurance and exceptional customer service
A strong commitment to C3s mission
Desired Other Skills:
Epic experience preferred
Familiarity with the MassHealth ACO program
Familiarity working in Federally Qualified Health Centers (FQHC)
Experience with anti-racism activities, and/or lived experience with racism is highly preferred
Qualifications:
High school diploma or equivalent required; Associates or Bachelors degree in business, accounting, or healthcare administration is preferred
Minimum of 2-4 years of self-pay collections or related experience
** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **
