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Healthcare Customer Service Representative

Newark, NJ
  • Expired: over a month ago. Applications are no longer accepted.
Job Description
We Are Hiring for Customer Service at Newark, NJ
Client: Healthcare
Title: Managed Care Coordinator/ Customer Service Representative
Location: Newark, NJ
Duration: 06 Months (possibility of extension or conversion)
  • Performs review of service requests for completeness of information, collection and transfer of non-clinical data, and acquisition of structured clinical data from physicians/patients.
  • Handles initial screening for pre-certification requests from physicians/members via incoming calls or correspondence based on scripts and workflows, and under the oversight of clinical staff.
  • Prepare, document and route cases in appropriate system for clinical review.
  • Initiates call backs and correspondence to members and providers to coordinate and clarify benefits.
  • Upon completion of inquiries initiate call back or correspondence to Physicians/Members to coordinate/clarify case completion.
  • Reviewing professional medical/claim policy related issues or claims in pending status.
  • Upon collection of clinical and non-clinical information MCC can authorize services based upon scripts or algorithms used for pre-review screening.
  • *Non Clinical staff members are not responsible for conducting any UM review activities that require interpretation of clinical information.
Required Skills:
• Requires knowledge of medical terminology.
Desired Skills:
• Prefer 1-2 years customer service or medical support related position.
• Prefer knowledge of contracts, enrollment, billing & claims coding/processing.
• Prefer knowledge Managed Care principles.
• Prefer the ability to analyze and resolve problems with minimal supervision.
• Prefer the ability to use a personal computer and applicable software and systems.
• 1-2 years customer service or medical support related position.
High School Diploma required. Some College preferred.
Managed Care,Customer Service,Customer Service Representative,Healthcare Customer Service,Medical Customer Service,Patient Care,Administrative Assistant,Healthcare Admin



Newark, NJ
07105 USA



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