礼宾客户服务代表 II
Concierge Customer Service Representative II
职责范围：这是一个需要出色客户互动技能和批判性思维的高级客户服务职位。该职位要求准确地为客户提供服务并满足其需求，包括根据雇主/第三方管理员与MedWatch之间的合同，处理有关健康福利的咨询，如预认证。礼宾/客户服务代表流动人员需要具备多样化的技能，能够应对工作的复杂性，并能同时协助礼宾部和接待部的来电者。
工作职责：
- 按照规定的客户服务标准，回应会员和提供者通过电话和电子邮件提出的咨询。
- 与提供者协商，以获得没有网络协议或非网络提供者的计划接受。
- 协助会员解答有关福利和医疗保健的问题。
- 在基于系统的呼叫日志中记录所有接收到的电话。
- 处理所有来自MedWatch的预认证电话（例如，启动案件、做呼叫日志、转接电话、提供案件状态、提供索赔电话号码等）。
- 进行MedWatch的外拨电话（演示、案件完成信息、网络引导的转介等）。
- 完成接收的电子Web-certs。
- 验证患者和提供者的个人信息——在需要时进行更正和/或补充。
知识、技能和能力：
- 强大的客户关系和人际交往能力。
- 对处理机密和敏感信息有良好的理解和能力。
- 熟练使用Microsoft应用程序，具备强大的计算机技能和操作能力。
- 优秀的数据输入和打字技能。
- 了解提供者组织和网络。
- 了解CMS Medicare报销费率。
- 能够有效协商费率结构。
- 有耐心，能够妥善且外交地处理困难情况。
- 主动解决问题，完成项目行动和任务。
- 优秀的口头和书面沟通能力。
- 在决策和问题解决中具备独立判断力。
- 能够多任务处理并预见潜在的需求/问题。
- 能够与内部和外部客户建立关系。
- 医疗术语知识
- 对细节有高度关注。
- 了解自付健康福利者优先考虑。
- 自付行业保险人的背景优先考虑。
- 索赔处理技能优先考虑。
- 保险
查看英文原文
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.
We are an Equal Opportunity Employer, including disability/veterans.Originally posted on Himalayas