Concierge Customer Service Representative II

Duties and Responsibilities

• Respond to telephone and email inquiries received from members and provider within defined service standards.
• Negotiate with providers to gain acceptance for plans without network agreements and/or out of network providers.
• Aid members with benefits and healthcare questions.
• Document all calls received in system-based call log.
• Handle all incoming MedWatch precertification calls (i.e., start cases, do call logs, forward calls, provide case status, provide claims phone #’s, etc.).
• Make outgoing calls for MedWatch (demos, information for case completion, re-direction for network steerage, etc.).
• Complete incoming electronic Web-certs.
• Verify patient and provider demos – correct and/or complete when needed.

Knowledge, Skills and Abilities

• Strong customer relations, interpersonal skills.
• Strong appreciation and ability to handle confidential & sensitive information.
• Proficient with Microsoft applications, strong computer skills and computer navigation.
• Excellent data entry and typing skills.
• Knowledge of provider organizations and networks.
• Knowledge and understanding of CMS Medicare reimbursement rates.
• Ability to effectively negotiate rate structures.
• Patience and ability to handle difficult situations tactfully and diplomatically.
• Takes initiative to resolve situations and to accomplish projects actions and tasks.
• Excellent verbal and written communication skills.
• Independent judgment in decision making and problem solving.
• Ability to multi-task & anticipate potential needs/problems.
• Ability to build relationships with internal and external customers.
• Medical Terminology
• Strong attention to detail.
• Understanding of Self-Funded health benefits a plus.
• Health Payor background preferable in self-funded industry a plus
• Claim processing skills a plus.
• Insurance verification or pre-certification a plus
• Provider office/facility billing department or financial area
• TPA experience a plus
• Strong analytical and research skills
• Bilingual a plus

Education

• Associate degree or higher preferred but not required, Minimum High School Diploma or G.E.D.

Experience

• Two Years Customer Service / Call Center experience in a health care related role.
• Medical Intake experience a plus

Pay Range

The pay range for this position is $19.00 to $20.00 hourly.

Work Environment / Physical Demands

This position is in a typical office/home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients.

We are an Equal Opportunity Employer, including disability/veterans.