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Form of work
SalaryPosition Summary:
Customer Service Specialists are responsible for learning and understanding the entire front-end process to ensure successful service for our patients. The Customer Service Specialists works in a fast-paced environment answering inbound calls and making outbound calls. May be responsible for obtaining, analyzing, and verifying the accuracy of information received from referrals, and schedule the patient.
Customer Service Specialists should educate Patients of their financial responsibility when applicable.
Essential Functions and Job Responsibilities:
- Develop and maintain working knowledge of current services offered by the company.
- Answer all calls and emails in a timely manner, in adherence to their goals.
- Document all call information according to standard operating procedures.
- Answer questions about services, retail stores, procedure information and other information as necessary based on customer call needs.
- Follow up on customer calls where necessary.
- Review all required documentation to ensure accuracy.
- Accurately process, verify, and/or submit documentation.
- Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles.
- Obtain pre-authorization if required by an insurance carrier for approval and authorization when required.
- Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
- Enter and review all pertinent information in EMR system including authorizations and expiration dates.
- Communicate with Billing Service and Management on an on-going basis regarding any noticed trends with insurance companies.
- Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered.
- Responsible for contacting patient when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.
- Meet quality assurance requirements and other key performance metrics.
- Facilitate resolution on customer complaints and problem solving.
- Pays attention to detail and has great organizational skills.
- Actively listens to patients and handle stressful situations with compassion and empathy.
- Flexible with the actual work and the hours of operation
- Utilize company provided tools to maintain quality. Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier),
- Develop and maintain working knowledge of current HME products and services offered by the company.
- Maintain patient confidentiality and function within the guidelines of HIPAA.
- Completes assigned compliance training and other educational programs as required.
- Maintains compliant with IPS’s Compliance Program.
- Assist operations with on-call responsibilities as needed during non-business hours in accordance with company policy.
- Depending on the geographic territory and size of the branch location, may require assisting operations in other positions.
- Retain knowledge of and consistently adhere to procedures for the use of Personal Protective Equipment (PPE), infection control and hazardous materials handling.
- Perform other related duties as assigned.
Competency, Skills and Abilities:
- Excellent customer service skills
- Must have knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements
- Analytical and problem-solving skills with attention to detail
- Decision Making
- Excellent ability to communicate both verbally and in writing.
- Ability to prioritize and manage multiple tasks.
- Proficient computer skills and knowledge of Microsoft Office
- Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.
- Work well independently and as part of a TEAM.
- Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
