About the Role
Position Summary:
This position will be responsible for daily member telephone calls which will include directing members to the proper services needed, educating members, problem solving, and creating linkages to the Medical Management Department for authorization of services. Also may be responsible for assisting providers with eligibility, benefit, and resolution of claims issues.
Essential Functions and Responsibilities:
Meet the Department standard of calls answered, and call documentation entered.
Assist Members and Providers with questions and concerns.
Finding Provider(s)/Services for members
Arrange Transportation for members
Answer billing/claims status questions; resolve claim issues for members
Assist with pharmacy issues
Help Members access community support services
Verify member eligibility
Quote benefits
Assist with Referrals
Assist with member health assessments • Assist members with closing gaps in care
Ongoing member education.
Responsible for all benefits information given to Members and Providers.
Participate in Departmental Projects, as appropriate.
Coordinate quality improvement initiatives with Medical Management, Provider Relations, and Quality Depts., i.e., Preventative Health Screenings.
Other duties as assigned or when necessary to maintain efficient operations of the department and the Company as a whole.
Requirements
Qualifications:
Required:
High School Diploma or equivalent certification;
One (1) year experience in a customer service related role with direct contact with customers via telephone, email, chat and/or face-to-face.
Preferred:
One (1) year experience in a physician health care office environment or high-volume call center.
One (1) year experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions.
About the Company
RepuCare is a leading provider of RPO staffing services in the Healthcare, IT, and Engineering Technology markets. We are partnered with a large managed healthcare client seeking Accounting Specialists for their team.