Customer Service Specialist

ActivStyle•Las Vegas, NV

8d•Onsite

About The Position

ActivStyle is seeking a compassionate and driven Customer Service Specialist for its Nevada office. This role involves being the primary point of contact for clients needing essential home-delivered medical supplies such as incontinence and urological items. The specialist will guide clients through accessing these products, ensuring they can live with dignity and independence. The position operates in a fast-paced environment, handling inbound and outbound calls, processing orders, verifying insurance, and educating patients on financial responsibilities. The company emphasizes a supportive, mission-driven culture focused on helping others.

Requirements

Excellent customer service skills
Analytical and problem-solving skills with attention to detail
Decision Making
Excellent ability to communicate both verbally and in writing
Ability to prioritize and manage multiple tasks
Proficient computer skills and knowledge of Microsoft Office
Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to work independently as well as follow detailed directives
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction
Computer skills including knowledge of Microsoft Office applications
High School Diploma or equivalent required
One (1) year work related experience relating to the products provided by the medical products provider or medical products wholesaler.
Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.

Nice To Haves

General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.
Associate's degree in a field of study that is directly related to patient healthcare.

Responsibilities

Develop and maintain working knowledge of current products and services offered by the company.
Answer all calls and emails in a timely manner, in adherence to their goals.
Document all call information according to standard operating procedures.
Answer questions about products and services, retail stores, general service line information and other information as necessary based on customer call needs.
Process orders, route calls to appropriate resource and follow up on customer calls where necessary.
Review all required documentation to ensure accuracy.
Accurately process, verify, and/or submit documentation and orders.
Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles.
Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required.
Navigate through multiple online EMR systems to obtain applicable documentation.
Enter and review all pertinent information in EMR system including authorizations and expiration dates.
Communicate with Customer Service and Management on an on-going basis regarding any noticed trends with insurance companies.
Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered.
Contact patient when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.
Meet quality assurance requirements and other key performance metrics.
Facilitate resolution on customer complaints and problem solving.
Utilize company provided tools to maintain quality.
Develop and maintain working knowledge of current HME products and services offered by the company.
Maintain patient confidentiality and function within the guidelines of HIPAA.
Complete assigned compliance training and other educational programs as required.
Maintain compliant with ActivStyle’s Compliance Program.
Assist operations with on-call responsibilities as needed during non-business hours in accordance with company policy.
Assist operations with deliveries, depending on the geographic territory and size of the branch location.
Retain knowledge of and consistently adhere to procedures for the use of Personal Protective Equipment (PPE), infection control and hazardous materials handling.
Perform other related duties as assigned.