Concierge Customer Service Representative II

Scope: This is a critical senior level customer service position requiring excellent customer interaction skills along with critical thinking. This individual is expected to accurately service and satisfy customers by responding to customer inquiries regarding health benefits including precertification based on the employer’s / Third Party Administrator’s contract with MedWatch. Concierge/Customer Service Representative Floater needs to be versatile and equipped with a strong skill set to handle the complexity of the job and the ability to assist callers in both the Concierge and Intake departments.

Duties and Responsibilities:

• Respond to telephone and email inquiries received from members and provider within defined service standards.
• Negotiate with providers to gain acceptance for plans without network agreements and/or out of network providers.
• Assist members with benefits and healthcare questions.
• Document all calls received in system-based call log.
• Handle all incoming MedWatch precertification calls (i.e., start cases, do call logs, forward calls, provide case status, provide claims phone #’s, etc.)
• Make outgoing calls for MedWatch (demos, information for case completion, re-direction for network steerage, etc.)
• Complete incoming electronic Web-certs.
• Verify patient and provider demos – correct and/or complete when needed.

Knowledge, Skills and Abilities:

• Strong customer relations, interpersonal skills.
• Strong appreciation and ability to handle confidential & sensitive information.
• Proficient with Microsoft applications, strong computer skills and computer navigation.
• Excellent data entry and typing skills.
• Knowledge of provider organizations and networks.
• Knowledge and understanding of CMS Medicare reimbursement rates.
• Ability to effectively negotiate rate structures.
• Patience and ability to handle difficult situations tactfully and diplomatically.
• Takes initiative to resolve situations and to accomplish projects actions and tasks.
• Excellent verbal and written communication skills.
• Independent judgment in decision making and problem solving.
• Ability to multi-task & anticipate potential needs/problems.
• Ability to build relationships with internal and external customers.

· Medical Terminology

· Strong attention to detail.

• Understanding of Self-Funded health benefits a plus.
• Health Payor background preferable in self-funded industry a plus

· Claim processing skills a plus.

• Insurance verification or pre-certification a plus
• Provider office/facility billing department or financial area

· TPA experience a plus.

· Strong analytical and research skills

· Bilingual a plus

Education:

• Associate degree or higher preferred but not required, Minimum High School Diploma or G.E.D.

Experience:

• Two Years Customer Service / Call Center experience in a health care related role.

· Medical Intake experience a plus

The pay range for this position is $19.00 to $20.00 hourly.

Work Environment / Physical Demands: This position is in a typical office/home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients.

Originally posted on Himalayas