Customer Service Specialist

ActivStyle•Fresno, CA

9d•Onsite

About The Position

ActivStyle is hiring an onsite Customer Service Specialist at its Fresno, California office. The company provides home-delivered medical supplies, including incontinence supplies, urological items, and other personal care products. The specialist learns and manages the front-end process for serving patients in a fast-paced environment, answering inbound calls and making outbound calls. Responsibilities may include gathering, analyzing, and verifying referral information, creating orders, scheduling patients to receive equipment prescribed by their doctors, and explaining patients’ financial responsibilities when applicable. The role requires accurate documentation and order processing, insurance and authorization work, patient education and follow-up, and compassionate handling of questions and complaints. The specialist must protect patient confidentiality, comply with HIPAA and company compliance requirements, complete assigned training, and may support after-hours on-call operations or deliveries as needed. The position involves extended computer use and sitting, occasional lifting, and possible exposure to stressful interactions and workplace hazards.

Requirements

High school diploma or equivalent.
At least one year of work-related experience in healthcare administrative, financial, or insurance customer service, claims, billing, call center, or management, regardless of industry.
Excellent customer-service skills and verbal and written communication abilities.
Analytical, problem-solving, decision-making, organizational, and attention-to-detail skills.
Ability to prioritize and manage multiple tasks, adapt to change, take initiative, remain accountable, and work effectively on a team or independently while following detailed directions.
Proficiency with computers and Microsoft Office; ability to learn new technologies and understand data flow and system interactions.
Ability to apply common-sense understanding to written, oral, or diagrammed instructions.
Ability to communicate empathetically, compassionately, courteously, and respectfully while protecting privacy.
Ability to bend, stoop, stretch, stand, and sit for extended periods; perform repetitive wrist, hand, or finger motions; and periodically lift 5 to 10 pounds.
Mental alertness to perform the essential functions of the position.

Nice To Haves

General knowledge of Medicare, Medicaid, commercial health-plan methodologies, and documentation requirements.
Experience performing the listed tasks in a Medicare-certified HME, diabetic-supply, pharmacy, or home-medical-supplies environment that routinely bills insurance.

Responsibilities

Develop and maintain knowledge of the company’s current products and services, including HME products.
Answer calls and emails promptly in accordance with performance goals; document call information according to standard operating procedures.
Answer questions about products, services, retail stores, and general service-line information.
Process orders, route calls to appropriate resources, and follow up with customers as needed.
Review, process, verify, and submit required documentation and orders for accuracy.
Verify insurance eligibility, coverage, coinsurance, and deductibles; obtain pre-authorization and submit physician orders to insurers for approval when required.
Navigate multiple online EMR systems to obtain documentation and enter and review patient information, including authorizations and expiration dates.
Communicate trends involving insurance companies to Customer Service and Management.
Confirm insurance carriers are listed in the company database and request additions when needed.
Contact patients when documentation does not meet payer guidelines, provide updates, and discuss options to facilitate the referral process.
Meet quality assurance requirements and other performance metrics; use company tools and guidelines to maintain quality.
Resolve customer complaints and problems while listening actively and responding with compassion and empathy.
Educate patients about financial responsibility when applicable.
Maintain patient confidentiality and comply with HIPAA, the company Compliance Program, and required compliance training and educational programs.
Assist operations with on-call responsibilities during non-business hours as needed and, depending on the branch and territory, assist with deliveries.
Follow procedures for personal protective equipment, infection control, and hazardous-material handling.
Perform other related duties as assigned.