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Customer Solutions Expert I - Staffing

Customer Solutions Expert I - Staffing

Job ID 
2017-3985
Job Locations 
US-KS-Overland Park
Category 
Customer Service Center

More information about this job

Overview

Identify the need(s) of the referring source and/or patient by collecting all necessary data relevant to that need; interpret, verify and process that data to determine if patient is eligible; and facilitate the initiation and termination of the care and services provided in a timely manner. Respond to customer issues that may arise during and after order processing. Actively engages and coordinates with other team members to maintain a positive, collaborative relationship. Works under close supervision.

 

PRIMARY RESPONSIBILITIES

 

• Works closely with health plans/payers and maintains strong business relationships.
• Provides appropriate issue resolution and/or escalation when needed. Works under moderate supervision, with clinical oversight.
• Reviews and adheres to all Company policies and procedures and the Employee Handbook.
• Participates in special projects and performs other duties as assigned.
• Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
• Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
• Participates in and contributes to performance improvement activities.
• Learn, understand and maintain working knowledge of products and services offered by the company.

Responsibilities

• Responsible for timely and thoughtful communication to the referral source, physician, and patient to ensure coordination of services and equipment to meet physician prescribed starts of care and/or discharge dates.
• Also responsible for communication to department leadership when difficulty securing a provider jeopardizes safe and timely care for a patient.
• Requests clinical input, and/or communicates with Client Services when quality of care issues are in question.
• Solicits providers in accordance with CareCentrix credentialing, quality, and pricing guidelines.
• When working outside of the CareCentrix network adheres to out-of-network qualification standards and ensures pricing is commensurate to CareCentrix client reimbursement.
• Consults with associates within internal CSC functions, as well as CareCentrix manuals and reference pages, to ensure issuance of service authorization forms (SAF) to providers in accordance with payer guidelines.
• Ability to take full accountability and ownership of a large case load from assignment of case ensuring patient discharges timely, or if already home that care begins per the physician’s request.
• Requires dynamic ability to prioritize multiple times throughout the day, as well as excellence in time management.
• Demonstrate critical thinking skills and utilize appropriate documentation to ensure URAC core and HUM standards are met.

Qualifications

• High School Diploma or the equivalent required. Associates or Bachelor’s degree preferred.
• One year billing, insurance or claims experience preferred.
• The ability to effectively multi-task.
• Medical terminology, insurance verification or healthcare experience preferred.
• Must be proficient and comfortable in a computer-based environment.
• Embraces the values of accountability, consistency, engagement, patient compassion, empowerment, respect and outstanding service.
• This position requires excellent communication, customer service and problem solving skills, as well as the ability to effectively interact with all levels of management and highly diverse customers.
• Must have strong organizational skills and be extremely detail-oriented.
• Demonstrates critical thinking and has the ability to analyze data to understand an expected outcome, Must be able to effectively manage and prioritize tasks and thrive in a fast-paced environment.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed below are representative of the knowledge, skill and/or ability required.
• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• Masters the Intake/Verifications function as well as a second function; Staffing as back-up and learns two health plans.

 

CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.