Job Title: Call Center Customer Service Representative
Job Type: Remote
Job Description :
This position is full-time (40 hours/week) with variable (varying) shifts to support our 24-hour-a-day, 7-days-per-week operations.
Employees must be able to work from 8am-5pm CST M-F during our 6-week training program. Post-training shifts may vary. Training will be conducted virtually from your home.
Primary Responsibilities:
- Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
- Providing excellent customer service, including the ability to handle escalated callers
- Determining authorization or notification requirements
- Preparing authorization cases for Medical Directors, Network Operations Nurses and Case Managers
- Providing administrative approvals (depends on line of business)
- Handling expedited authorizations, authorization updates and status checks
- Confirming member eligibility
- Outreaches to providers and/or Patient to complete authorization requests and prescriptions
- Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
- Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
- Non-Clinical staff is not responsible for conducting any Network Operations activity that requires interpretation of clinical information.
- Performs all other related duties as assigned.
Qualifications:
Required Qualifications:
- High School Diploma / GED (or higher)
- 2+ years of combined or related experience in a healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
- Ability to work one of the varying shift to support our 24hr 7 days a week operations
- Proficiency with Microsoft Office Word (create and maintain documents), Excel (create and maintain spreadsheets) and Outlook(email and calendaring)
Preferred Qualifications:
- Associate’s Degree (or higher) in a healthcare related field
- Medical Terminology
- ICD-9/ICD-10 and CPT Knowledge
Telecommuting Requirements:
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive high-speed internet connection or leverage an existing high-speed internet service
How to Apply:
Interested and qualified candidates should click on ‘Apply now’ below.
