Customer Service Representative
Company Name:
Tenet
Title: Customer Service Representative
Location: AZ-Phoenix
Other Locations:
Overview:This position has responsibility of answering incoming calls from providers and members as they relate to eligibility, benefits, claims, coverage and authorization of services. This position will also problem-solve and explain programs and procedures to callers and will answer/address claim payment questions with members and providers. Primary duties include the following:
Able to deal effectively with customers on a one -on - one basis and demonstrate appropriate customer care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
Interact with customers (internal and external) by understanding inquiry and provide accurate and timely responses about benefits, authorizations, services and claims.
Gather information, research, resolve inquiry and record in customers account / health plan database system.
Communicate appropriate options for resolution in a timely manner and escalates inquires to appropriate staff as required.
Accurately and efficiently processes assigned outbound calls to members that include outreach to members regarding health services and appointments. Track and monitor inbound & outbound calls for regulatory compliance.
Identify, record and refer member grievances/complaints according to internal policy and regulatory guidelines. Identify potential member appeals and provide appropriate instructions and guidance to the caller.
Maintain working knowledge in all lines of business and adhere to production standards that includes service availability, calls returned to the queue, use of scripts and agent complaints.
Adhere to company Standards of Behavior. Adhere to work schedule s and comply with attendance and other stated policies.
Uses, protects and discloses members protected health information (PHI) in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Special Skills:Must have the ability to learn quickly, deliver high quality customer service and thrive in a production-based environment where first call resolution is a must. Must be customer service oriented team player, focused, articulate and possess good phone etiquette. Must maintain member and provider confidentiality at all times, demonstrate effective problem solving skills and be punctual and maintain good attendance. Be able to demonstrate computer proficiency and the ability to maneuver and navigate between computer screens and programs. Critical thinking/problem-solving, judgment and decision making skills, strong 10-key data entry and general numerical analytical skills required. Bi lingual English / Spanish preferred, but not required.
Minimum Requirements:High school diploma or G.E.D. required. Must have a minimum of two years of customer service experience preferably in a Medicaid, Medicare or Commercial healthcare environment. Working knowledge of Microsoft Office.
Preferred
Qualifications:
Associates Degree in Healthcare, Sales, or Business preferred. Knowledgeable in ICD-9, CPT and HCPCS coding preferred.Estimated Salary: $20 to $28 per hour based on qualifications.
Tenet
Title: Customer Service Representative
Location: AZ-Phoenix
Other Locations:
Overview:This position has responsibility of answering incoming calls from providers and members as they relate to eligibility, benefits, claims, coverage and authorization of services. This position will also problem-solve and explain programs and procedures to callers and will answer/address claim payment questions with members and providers. Primary duties include the following:
Able to deal effectively with customers on a one -on - one basis and demonstrate appropriate customer care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.
Interact with customers (internal and external) by understanding inquiry and provide accurate and timely responses about benefits, authorizations, services and claims.
Gather information, research, resolve inquiry and record in customers account / health plan database system.
Communicate appropriate options for resolution in a timely manner and escalates inquires to appropriate staff as required.
Accurately and efficiently processes assigned outbound calls to members that include outreach to members regarding health services and appointments. Track and monitor inbound & outbound calls for regulatory compliance.
Identify, record and refer member grievances/complaints according to internal policy and regulatory guidelines. Identify potential member appeals and provide appropriate instructions and guidance to the caller.
Maintain working knowledge in all lines of business and adhere to production standards that includes service availability, calls returned to the queue, use of scripts and agent complaints.
Adhere to company Standards of Behavior. Adhere to work schedule s and comply with attendance and other stated policies.
Uses, protects and discloses members protected health information (PHI) in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Special Skills:Must have the ability to learn quickly, deliver high quality customer service and thrive in a production-based environment where first call resolution is a must. Must be customer service oriented team player, focused, articulate and possess good phone etiquette. Must maintain member and provider confidentiality at all times, demonstrate effective problem solving skills and be punctual and maintain good attendance. Be able to demonstrate computer proficiency and the ability to maneuver and navigate between computer screens and programs. Critical thinking/problem-solving, judgment and decision making skills, strong 10-key data entry and general numerical analytical skills required. Bi lingual English / Spanish preferred, but not required.
Minimum Requirements:High school diploma or G.E.D. required. Must have a minimum of two years of customer service experience preferably in a Medicaid, Medicare or Commercial healthcare environment. Working knowledge of Microsoft Office.
Preferred
Qualifications:
Associates Degree in Healthcare, Sales, or Business preferred. Knowledgeable in ICD-9, CPT and HCPCS coding preferred.Estimated Salary: $20 to $28 per hour based on qualifications.
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