Note: The job is a remote job and is open to candidates in USA. MedWatch, LLC is seeking a Concierge Customer Service Representative II to provide critical customer service support related to health benefits and precertification. The role responds to member and provider inquiries, assists with healthcare questions, manages precertification calls and electronic Web-certs, and supports both Concierge and Intake departments.
Responsibilities
- 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
- Handle all incoming MedWatch precertification calls (i.e., start cases, do call logs, forward calls, provide case status, provide claims phone #’s, etc.)
- Make outgoing calls for MedWatch (demos, information for case completion, re-direction for network steerage, etc.)
- Complete incoming electronic Web-certs
- Verify patient and provider demos – correct and/or complete when needed
Skills
- · 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
- · Patience and ability to handle difficult situations tactfully and diplomatically
- · 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 & anticipate potential needs/problems
- · Ability to build relationships with internal and external customers
- · Medical Terminology
- · Strong attention to detail
- · Provider office/facility billing department or financial area
- · Strong analytical and research skills
- · Minimum High School Diploma or G.E.D
- · Two Years Customer Service / Call Center experience in a health care related role
- · This position is in a typical office/home office environment which requires prolonged sitting in front of a computer
- · Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment
- · Associate degree or higher preferred
- · Understanding of Self-Funded health benefits a plus
- · Health Payor background preferable in self-funded industry a plus
- · Claim processing skills a plus
- · Insurance verification or pre-certification a plus
- · TPA experience a plus
- · Bilingual a plus
- · Medical Intake experience a plus
Company Overview