Customer Service Representative

Duties and Responsibilities

• Answer incoming phone calls from customers and identify the type of assistance the customer needs.
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
• Own problems through to resolution on behalf of the customer/patients in real time through comprehensive and timely follow-up with the member of the specified date given to patients.
• Review and research incoming healthcare claims for patients (clinics, etc.) by navigating multiple computer systems and platforms and verifies the data/information necessary for answering any and all questions regarding their claim.
• Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures benefit plan.
• Communicate and collaborate with patients to resolve issues, using clear, simple language to ensure complete understanding of their bill/statement.
• Review and sign all written instructions for any and all duties, duties will be subject to change and ample notice will be given.
• Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance.
• Problem solving by identifying and resolving patient billing issues.
• Demonstrates excellence in Customer Service when speaking with patients on the phone.

Competencies

• Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
• Design - Generates creative solutions; Translates concepts and information into images; Uses feedback to modify designs; Applies design principles; Demonstrates attention to detail.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Techical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• Ethics - Treats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
• Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; supports organization's goals and values.
• Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.
• Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.

Education Requirements

• A High School Diploma

Experience Requirements

• 1 year of experience in Customer Service in Medical environment such as a clinic, hospital or ER

Special Knowledge, Skills and Abilities Required

• Knowledge of principles and processes for providing customer services: including customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Knowledge of medical billing and collection practices
• Knowledge of basic medical coding and third-party operating procedures and practices.
• Maintains confidentiality of patient data and medical records in compliance with HIPAA guidelines and regulations
• EMR, EDI and Commercial Insurance Company systems
• Ability to represent the company in a professional manner and handle patient issues with sensitivity and confidentiality.
• Detail oriented and accurate data entry skills
• Strong organizational skills and the ability to prioritize workload

Working Environment

• Ability to work in a fast-paced, high volume and dynamic environment.
• Able to flex hours and overtime to meet need related to unanticipated volume, changes and/or problems.

Benefits

(Not specified)

Schedule

(Not specified)

Pay

(Not specified)