Customer Service Representative (Medical)
About The Position
The Customer Service Representative (Medical) handles customer and patient communications and supports the referral and order process. The role makes outbound calls using call center software, answers calls and emails promptly, documents interactions according to standard procedures, answers questions about products and services, processes orders, routes calls, and follows up as needed. The representative reviews and processes documentation and orders, verifies insurance eligibility and coverage, obtains pre-authorization when required, and submits physician orders to insurance carriers for approval. The role uses multiple online EMR systems to access and enter information, including authorization details and expiration dates. It also contacts patients when documentation does not meet payer guidelines, helps resolve customer complaints, and communicates observed insurance trends to Customer Service and Management. The position is fully onsite in Plattsburgh, New York, and is contract-to-hire.
Requirements
- Customer service skills.
- Computer skills.
- Data-entry skills.
- Attention to detail and strong organizational skills.
- Ability to actively listen and handle stressful situations with compassion and empathy.
- Flexibility regarding work duties and hours of operation.
Responsibilities
- Make outbound calls using call center software.
- Maintain working knowledge of current company products and services.
- Answer calls and emails in a timely manner and document call information according to standard operating procedures.
- Answer questions about products, services, retail stores, service line information, and other customer needs.
- Process orders, route calls to appropriate resources, and follow up on customer calls as necessary.
- Review documentation for accuracy and process, verify, or submit documentation and orders.
- Verify insurance eligibility, coverage, co-insurances, and deductibles.
- Obtain pre-authorization when required and submit physician orders to insurance carriers for approval and authorization when required.
- Navigate multiple online EMR systems to obtain documentation and enter or review pertinent information, including authorizations and expiration dates.
- Communicate with Customer Service and Management about observed insurance-company trends.
- Verify insurance carriers are listed in the company database and request entry of new carriers when necessary.
- Contact patients when documentation does not meet payer guidelines, provide updates, and offer options to facilitate the referral process.
- Meet quality assurance requirements and key performance metrics.
- Help resolve customer complaints and problems.
- Use company-provided tools to maintain quality.
Benefits
- Medical insurance, if eligible.
- Dental insurance, if eligible.
- Vision insurance, if eligible.
- Critical Illness, Accident, and Hospital coverage, if eligible.
- 401(k) retirement plan with pre-tax and Roth post-tax contributions available, if eligible.
- Voluntary life and AD&D insurance for employees and dependents, if eligible.
- Short- and long-term disability, if eligible.
- Health Spending Account (HSA), if eligible.
- Transportation benefits, if eligible.
- Employee Assistance Program, if eligible.
- Time off/leave, including PTO, vacation, or sick leave, if eligible.
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What This Job Offers
Career Level
Entry Level
Education Level
No Education Listed
