Job Description
Call Center / Customer Service - Customer Service Rep 1
Shift Schedule: 08:00:AM-05:00:PM [Lunch: 12:00:PM-01:00:PM]
Job Description
Verifies insurance benefits for new patient referrals and re-verifies existing patient benefits as indicated by policy. Obtains pre-certifications, pre-determinations, and authorizations for services per insurance guidelines. Evaluates profitability of therapies and communicates issues.
Essential Functions and Duties
o Manage work queue to department standards for productivity and quality.
o Verifies insurance benefits for new patient referrals.
o Re-verifies insurance benefits for existing patients.
o Accurately evaluates charge and reimbursement estimates for infusion therapies.
o Reviews all medical documentation against medical policy and initiates/obtains pre-determination, pre-certification, and authorizations as needed.
o Follow-up on pending pre-certifications and/or pre-determinations until outcome decided.
o Updates and maintains insurance and authorization information in billing software.
o Obtains PCP referrals as needed.
o Completes special projects as assigned.
o Performs other job-related duties as assigned.
Minimum Requirements
o Two or more years of related experience in a healthcare industry, preferably intake/patient access experience.
Critical Skills
o Must be able to communicate effectively, both orally and in writing.
o Must demonstrate an understanding of reimbursement practices including government program regulation and managed care contracting
o Experience working in, and managing changing priorities, in a high volume, fast-paced work environment.
Excellent personal computing skills and a working knowledge of MS Office software
o Maintains clear communication with customers regarding mutual expectations. Takes personal responsibility and accountability for correcting customer- service problems.
Additional Knowledge and Skills
o Ability to work well as part of a collaborative team as well as independently.
Education
o High School diploma or equivalent
Physical Requirements
o Professional office environment
Remote Opportunity must be local to Houston area