CareCentrix

Customer Solutions Expert I - Staffing

Job Locations US-KS-Overland Park
Job ID
2018-5123
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.

 

• 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

• Requires a HS diploma or equivalent; up to 1 year of previous related experience; or any combination of education and experience, which would provide an equivalent background.
• 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.

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed