CareCentrix

Customer Solutions Expert I - iComply

US-CT-Hartford
Job ID
2017-4921
Category
Customer Service Center

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

• Receives and responds to incoming calls or faxes from providers, referral sources, and potential patients.
• Communicate with carrier/health plan representatives, providers, and patients.
• Provides issue resolution and escalation to management when appropriate.
• Timely notification to payers, providers, and patients of therapy or other care status.
• Accurately documents all communications and decisions into a computer database.
• Understand and evaluate patient PAP adherence reports and other mechanisms of therapy.
• Consults applicable Payer Fact Sheets and other available resoureces. Works with other staff and patients to identify potential solutions as problems are identified.
• Assures the completion and coordination of work in an associate’s absence, or as needed, to maintain departmental standards.
• Follows up with servicing providers to ensure authorization to completion as well as ensures timely delivery of services.
• Participates in special projects and performs other duties as assigned.

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.

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