Tasks for Customer Service Rep * Responds to telephone inquiries from members and providers. *(80%) Provides information on eligibility, benefits, provider network, etc. Provides callers with information requested, explains Web Portal use, offers Post Call Survey after every call. CSR will be trained for primary plan (WV) initially, then will continue training to add other plans. *Documents all calls in QNXT call tracker. Makes referrals to care management or utilization management when appropriate.
Knowledge of health insurance, specifically Medicaid a plus. The primary responsibilities are to verify eligibility and benefits for Medicaid members. Additionally, this person will assist members in selecting in-network providers, provide any written materials as requested and successfully and demonstrate excellent customer services to all callers. This role will require an understanding of insurance concepts, strong attention to detail, and proven analytic and problem solving.
Tasks for Customer Service Rep can differ per location: Effective delivery of company products and services (40%) * Responds to telephone inquiries and orders from homecare patients and referral sources. * Provides information on equipment, supplies and services. Determines the best method for providing services. * May assist walk-in patients with the selection of equipment, supplies and services. Timely processing/facilitation of patient orders (30%) * Processes telephone orders by preparing patient paperwork. * Verifies insurance and/or other method of payment. * Completes all necessary paperwork in an accurate and efficient manner to facilitate the data entry, accounts receivable and delivery of the order placed. * May perform data entry. * Distributes copies of paperwork to appropriate personnel. * May assist with the processing of billing paperwork. Effective coordination of patient services/supplies (10%) * Coordinates the delivery, set-up and pick-up of equipment, supplies and services with appropriate personnel. * Ensures deliveries and set-ups can be arranged in a timely manner. Appropriate documentation (10%) * Accurately maintains files of all patient account profile information and referral source data. Customer satisfaction (10%) * Resolves patient complaints by identifying problems and coordinating appropriate corrective action.
Knowledge of Medicare, Medicaid, and 3rd party vendors is a plus. The primary responsibilities are to verify insurance coverage for potential new clients. Additionally, this person will re-verify insurance coverage for existing patients in order to process patient prescription needs successly and demonstrate excellent customer services to patients, healthcare professionals, and insurance carriers. This role will require an understanding of insurance concepts, including drug cards, major medical benefits, and per diem coverage, as well as knowledge of government and patient assistance programs. Strong attention to detail, and proven analytic and problem solving.
* Minimum of 1 year in a customer service or call center environment (call center type environments preferred, if doctors office then anything below managing 75 calls/day would not translate to similar environment). * Must have effective and empathetic communication style in managing inbound calls and communications with clients and team members. * Computer experience is required with proficiency in Microsoft Outlook, Word and Excel. * Basic alpha number data entry skills with attention to accuracy and quality is essential. * Intermediate math skills are required with attention to detail and quality essential. * Experience in a health care setting or insurance industry is a plus, including knowledge of basic insurance and third party terms and medical terminology. * Ability to work with people in a team environment while meeting individual performance goals. * Must be able to read and interpret policies, procedures and instructions. * Effective organizational skills and ability to prioritize a fluctuating workload and competing priorities is essential.
High School diploma or GED
Source : Integrated Resources, Inc