Concierge Customer Service Representative
Minimum HS Diploma/GED, 2 years college or higher education preferred. Experience:
One year Customer Service / Call Center experience in a health care related role. Medical Intake or Third-Party Administrator (TPA) experience preferred. Bilingual English-Spanish a plus. Requirements/Skills:
- Patience and ability to handle difficult situations tactfully and diplomatically. • 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.
- 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 and 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.
- Claim processing skills a plus.
- Insurance verification or pre-certification a plus
- Provider office/facility billing department or financial area.
- Strong analytical and research skills
- Bilingual English-Spanish a plus.
- 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.
- The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice
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