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Customer Support Representative I
Company | AltaMed Health Services |
Address | Montebello, CA, United States |
Employment type | FULL_TIME |
Salary | |
Category | Wellness and Fitness Services |
Expires | 2023-08-24 |
Posted at | 9 months ago |
Overview
- Provide superior customer service to all incoming callers to ensure an exceptional customer experience.
- Use appropriate subject codes, accurately, thoroughly, and clearly document all inquiries in tracking systems.
- Responsible for research, resolution, or escalation of provider inquiries regarding eligibility, claims status, check tracer, EOB requests and payment disputes.
- Actively participate in all departmental meetings, training sessions, and other activities.
- Make outbound calls for follow up purposes when needed. Set reasonable follow up expectations with callers and meet or exceed those commitments.
- Educate callers on the use of the member and provider web portal.
- Continuously work on open inquiry log and maintain minimal open cases.
- Provide assistance with inquiries such as eligibility, authorizations status, claims status PCP changes, appeals and grievance intake, and various other inquiries.
- Assist with training of new and existing staff when called upon.
- Properly identify member’s health plan assignment for appropriate re-directing when necessary.
- Collect, verify, and update member demographic information information systems.
- Interface with other departments regarding questions about provider configuration or other relevant provider issues.
- Use DOFR, benefit schedules, and other resources to identify issues with claims payments.
- Handle of complex claims inquiries.
- Perform other duties as assigned.
- Receive and respond to incoming calls from members, member advocates, providers, health plan representatives, etc. Identify and resolve issues related to patient care and services.
- Assist callers in connecting with other internal departments or external parties such as partner PCP offices, health plans, pharmacies, etc.,
- Recognize and alert management of inappropriate trends during customer calls. Provide process improvement recommendations.
- Adhere to individual and departmental key performance indicators (KPIs) such as number of inbound calls per day, wrap up time, handle time, QA audit performance, abandonment rate, and service level.
- Maintain confidentiality of all protected health information in accordance with corporate guidelines.
- Conduct provider education related to claims.
- Minimum of 1 year in medical or healthcare environment preferred.
- High School Diploma or GED required. Associates or bachelor’s degree preferred.
- Minimum of 2 years of ACD call center experience
- Bilingual in Spanish required.
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