Member Services/Customer Service Reps
Bilingual Spanish, Chinese, Vietnamese
Under general supervision, following established procedures, assist and direct patients and or providers in an empathetic and caring manner, efficiently and timely, and complete appropriate documentation. Respond to provider inquiries and attempt to resolve provider concerns or refer to management for resolution.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Comply with UM, Claims, Member Services policy and procedures.
- Read all new P&P’s and review others annually as needed
- Answer incoming calls from our customers to include but not limited to: members, providers, health plans, insurance brokers, and hospitals in accordance with HIPAA guidelines.
- Research and resolve authorizations, claims, eligibility inquiries and any additional concerns in a timely fashion.
- Accurate documentation of calls into customer service module using appropriate wrap up codes.
- Educate contracted providers about TAT’s, Portal access and other information as needed, document provider education in customer service module
- High School Graduate or equivalent
- A minimum of one-year Healthcare related experience in managed care environment to include but not limited to an IPA, MSO or health plan preferred
- Current knowledge of Managed Care UM and Claims procedures
- Knowledge of medical terminology, CPT, HPCS, ICD-10 codes
- Proficient with Microsoft applications
- Must be able to Type 40 or more WPM
- Bilingual spanish, chinese, vietnamese