IMPORTANT- This is a Work At Home position (including training) but candidates must be local to area.
SHORT TERM ASSIGNMENT WITH OPPORTUNITY TO BE EXTENDED BUT CANNOT BE GUARANTEED
A speed test will need to be completed to ensure they have the appropriate speed, if not they will need to upgrade speed (additional cost not convered by client). They need 20 mbps download speeds.
Separate space with no distractions where they can close the door client suppies the phone/PC. Will need to have a desk and chair
Confidentiality of information
Breaks and lunches at scheduled time
The CSR positions provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members.
As a CSR you will be part of our fast paced Clinical Call Center where you will engage with providers on a daily basis, answering about 30-50 calls per day where you will assist providers with determining the service they will be providing to a member requires authorization or referral; the provider may be calling in to get status of an authorization; the provider may be calling in to provide clinical information for a pended authorization. As a CSR you will be collecting clinical information and reviewing resources and data to determine positive outcomes for our consumers. This position requires the use of multiple systems, therefore the ability to maneuver multiple systems at one time is vital. In this role you will:
o Take inbound calls to engage members and/or providers to verify clinical information
o Handle customer inquiries both telephonically and by fax
o Document all call information according to standard operating procedures and attach clinical information when necessary
o Identify and escalate issues
o High School Diploma
o Excellent verbal and written communication skills
o Ability to multitask within several computer systems while on the phone
o Aptitude for quickly learning and navigating new technology systems and applications
o Must be able to type while taking calls
o Proficiency in Microsoft Office applications, including Word and Excel
o Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 20Mx1M
o Proficient utilizing electronic medical record and documentation programs
o Proficient and/or experience with medical terminology and/or ICD-10 codes
o Bachelor's Degree in Business, Finance or a related field
o Prior member service or customer service telephone experience desired
o Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization