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.
• Accurate and complete data collection from referrals and completion of applicable paperwork. Interpret, verify and accurately enter data into computer to process orders.
• Answers telephone calls in a professional, friendly, helpful manner.
• Ensure patient qualifies for the type and quantity of product(s) ordered, based upon the patient’s insurance and/or SMS contract guidelines.
• Obtain insurance authorization, when necessary.
• Promptly respond to and resolve customer issues.
• Requires a High School Diploma or the equivalent. Must have minimum 1 year work experience.
• 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.
We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.