Serves as a subject matter expert for El Paso Health call center activities including all inbound and outbound Member or Provider inquiries or concerns (written or verbal). Sets the example in providing a high level of Member and Provider satisfaction, with the ability to resolve any Provider or Member issue as appropriate within the timeline allowed. Focuses on multiple line of business, which may include but is not limited to Medicare, Medicaid, CHIP, Health Care Options (HCO), and Third Party Administration (TPA) programs. Adheres to a weekly rotating shift schedule.
1. Excellent bi-lingual oral/written skills in English and Spanish highly preferred.
2. Excellent interpersonal skills.
3. Strong knowledge of Microsoft Office programs.
4. Computer awareness and willingness to learn data entry required.
5. Performs the basic functions or arithmetic; add, subtract, multiply, and divide all units of measure.
6. Performs reading, writing, and speaking at all intermediate level, demonstrating good oral and written communication skills as well as attention detail.
7. Excellent customer service and communication skills as demonstrated by past experience.
Three years of experience working in a call center environment within the healthcare industry required, preferably with experience in Medicare, Medicaid, CHIP and/or Third Party Administration. Two years of coding experience with CPT, HCPCS, and ICD-10 diagnostic coding required. Versed in member benefits and enrollment, prescription drug benefits, and provider claims and billing with the ability to understand, analyze, and remediate issues. Claims processing/adjudicating and medical billing experience preferred.
CPT Coding Certification preferred.
Education and Training
High school diploma or GED equivalent.