Customer Service Specialist

Job Description:

• Develop and maintain working knowledge of current products and services offered by the company
• Answer inbound calls and emails promptly and make outbound calls
• Document call information according to standard operating procedures
• Answer questions about products, services, retail stores, and general service line information
• Process orders, route calls to appropriate resources, and follow up on customer calls
• Review required documentation for accuracy
• Process, verify, and/or submit documentation and orders
• Complete insurance verification to determine patient eligibility, coverage, co-insurances, and deductibles
• Obtain pre-authorization when required and process physician orders to insurance carriers
• Navigate multiple online EMR systems to obtain applicable documentation
• Enter and review pertinent information in the EMR system, including authorizations and expiration dates
• Communicate with Customer Service and Management regarding trends with insurance companies
• Verify insurance carriers are listed in the company database and request additions when needed
• Contact patients when documentation does not meet payer guidelines, provide updates, and offer options to facilitate referrals
• Meet quality assurance requirements and key performance metrics
• Resolve customer complaints and problems
• Use company-provided tools, including Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI, PECOS, and “How-To” documents

Requirements:

• High School Diploma or equivalent
• One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry
• Senior level requires two (2) years of work-related experience and one (1) year of exact job experience
• Proficient computer skills and knowledge of Microsoft Office
• Solid ability to learn new technologies and understand flow of data through systems and system interaction
• General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred
• Excellent customer service skills
• Analytical and problem-solving skills with attention to detail
• Excellent verbal and written communication skills
• Ability to prioritize and manage multiple tasks
• Ability to work independently and as part of a group
• Ability to adapt and be flexible in a rapidly changing environment
• Must be patient, accountable, proactive, take initiative, and work effectively on a team