Healthcare Call Center Representative
Kolter Solutions Rockledge, FL
- Expired: 29 days ago. Applications are no longer accepted.
Kolter Solutions is seeking a Clinical Support Specialist to work with a great client. In this role you will provide Quality/No Harm, Customer Service and Stewardship by enabling and supporting responsibilities associated with Utilization Management and Case Management, to include all non-clinical functions, to optimize customer satisfaction and positively impact productivity. Success in this position will be based on the individual's ability to effectively prioritize and manage work in an accountable and responsible manner and consistently meet departmental standards for production and quality.
Location: Remote but must live driving distance from Rockledge, FL
-Provides accurate and professional service to Customers.
-Demonstrates sensitivity and shows pro-active behavior in addressing customer needs.
-Interacts with clients interdepartmental associates to resolve issues both timely and efficiently.
-Responds to Customer inquiries related to: Authorization requests, decisions and extensions; Benefit coverage and exclusions; Eligibility; Plan Providers; Claims payments and non-payments.
-Customer Centric approach to daily activities and outcomes.
-Maintains confidentiality and adheres to HIPAA requirements.
-Maintains a clean/safe work environment.
-Properly identifies and elevates clinical issues to the appropriate associate level.
-Coordinates Utilization Management and Case Management intake activities
-UM and CM data is entered into systems with accuracy and completeness.
-Demonstrates knowledge of accreditation and regulatory Utilization Management and Case Management requirements.
-Achieves individual productivity metrics set by management.
-Contributes towards departmental performance
-Any experience in a call center or administrative function within the Healthcare or Health Insurance industry preferred
-Minimum 1+ year in clinical or health care insurance administrative setting, call center setting or other customer supporting role preferred
-Ability to accurately type 45 wpm while speaking with provider/member/vendor or other via telephone
-Strong data entry skills required
-Strong attention to detail and quality of work product
-Strong knowledge of medical terminology and familiarity with medical scenarios required
-High school diploma or GED required
-Computer Skills e.g. navigation and workflow within an EMR, Benefit Administrative system(s) or medical management applications and Microsoft Office Applications required
-Knowledge of clinical coding preferred
-Knowledge of HIPAA compliance requirements preferred
-Knowledge of Medical and Hospital Claims preferred
Kolter Solutions is a leading professional staffing company based in Central Florida. We place highly skilled individuals on a contract, contract-to-hire and direct hire positions at clients nationwide.
Kolter Solutions has proudly been recognized as the "Best Places to Work” by the Orlando Business Journal and Staffing Industry Analysts (SIA). We are also in the Fast 50 – 2020 Fastest growing companies in Central Florida!
- Full Health Benefits
- 401 (k)
- Pet Insurance
- Life Insurance
- Supplemental Benefits such as short-term disability, accidental insurance, and supplemental dental and vision.
- Employee Discounts
- Referral Program
Kolter Solutions is an Equal Opportunity Employer. We believe in hiring a diverse workforce and sustaining an inclusive, people-first culture. We are committed to non-discrimination on any protected basis, such as disability and veteran status, or any other basis covered under federal, state or local applicable law.