Due to growth of our company and department, we are looking to expand our team. Bring your excellent customer service skills to the Provider Customer ServiceProfessional I role! As a Provider Customer Service Professional I, you will provide information, education and assistance to providers, other healthcare professionals, or other provider representatives on recorded phone lines regarding benefits, claims and eligibility. Provide excellent and caring services to all providers. In addition you will:
- Be the primary contact between the corporation and providers.
- Quickly and accurately assess provider inquiries and requirements.
- Identify errors promptly and determine what corrective steps may be taken to resolve errors.
- Determine benefit payments, maximum allowable fees, co-pays, and deductibles from appropriate contracts.
- Explain benefits, rules of eligibility and claims payment procedures, pre-authorizations, medical review and referrals, and grievance/appeal procedures to providers to ensure that benefits, policies and procedures are understood.
Key Qualifications and Experience
- Government Programs related jobs, demonstrated thorough knowledge of State and Federal regulations
Provider Customer Service Professional I would have a high school diploma or equivalent and 1 year customer service call center experience or 1 year customer service experience such as insurance, retail, banking, restaurant, hospital medical office or other experience with extensive customer service contact or equivalent combination or education and experience.
- Keyboarding skills of 30 wpm with 95% accuracy
- Proficient PC skills and prior experience in a PC environment
- Demonstrated Knowledge of medical terminology and coding preferred
- Ability to apply mathematical concepts and calculations
- Ability to communicate effectively orally and in writing with understanding and ability to apply correct punctuation, spelling, grammar and proof-reading skills.
- Demonstrated ability of strong customer-service skills, including courteous telephone etiquette
- Ability to make decisions and exercise good judgment in a complex and rapidly changing environment
- Ability to adapt to a fast-paced environment and learn, retain, and interpret new or evolving information, procedures, and policies and communicate them effectively
- Ability to work under stress and pressure and respond to inquiries with tact, diplomacy and patience
- Ability to work in a team environment
- Ability to exercise discretion on sensitive and confidential matters
- Demonstrate initiative in researching and resolving benefit, and eligibility issues
Customer Service Professionals work Monday through Friday between from 7am – 6pm. To show our dedication to employee satisfaction, our generous benefit package starts on your first day. Our leadership team is committed to creating a supportive, fun, and empowering environment where you’ll gain skills and experience in an ever-changing health care industry and have a positive effect on your local community.