Description: Our client is currently seeking a Customer Service / Healthcare Preferred
- Respond to Incoming Provider and Enrollee calls Resolve Customer Service inquiries
- Provide excellent Customer Service to both Providers and Enrollees Meet established productivity, schedule adherence, and quality standards while maintaining good attendance
- Receive Care Coordination notification cases for non – clinical assessment / intervention and provides appropriate triage
- Process out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate products Process notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issues
- Determine benefit coverage issues based on employer group contracts Set up / document / triage cases for (CCR) Clinical Coverage Review
- Ensure all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicable
- Process letters within DOL time frames Verify appropriate ICD – 10 and CPT coding usage Communicate to providers and members benefit determinations within DOL time frames
- Assist with faxes and emails Moderate work experience within own function
- Some work is completed without established procedures
- Basic tasks are completed without review by others Supervision / guidance is required for higher – level tasks Other duties as assigned by manager and / or director
You?ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
High School Diploma / GED (or higher) 1+ years of professional experience in an office / customer service environment Healthcare experience
Experience working with Microsoft Outlook, Microsoft Word, and Microsoft Excel (ability to create, edit, save and send emails, documents and spreadsheets)
Computer experience including, but not limited to, ability to learn new computer system applications Ability to work Tuesday – Saturday, Sunday – Thursday, or Monday – Friday between 8:00 am – 6:00 pm (40 hrs per week)
MUST live in a commutable distance from Farmingdale NY office @ 2805 Veterans Memorial, Ronkonkoma NY 11779.
Flexibility to work outside standard hours of operations due to changing business needs If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener.
In addition, employees must comply with any state and local masking orders Full COVID-19 vaccination is an essential requirement of this role. The client will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
Preferred Qualifications:
Bachelor’s Degree (or higher) Professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties OR customer service experience analyzing and solving customer problems
Experience working within a Hospital, Physician’s Office, or Medical Clinical setting, Medical Terminology, ICD – 10 and CPT codes, Medicare and / or Medicaid Services, Call Center environment Professional experience in a Clerical or Administrative support related role Bilingual fluency in English and Spanish
Contact:
[email protected]?subject=Customer%20Service%20%2F%20Healthcare%20Preferred
Source: Monster.com
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