Posting ID : A1068487169
Date Posted : 2015-08-18
Category : Healthcare
Client Service Representative
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2 years - Healthcare related Customer Service, Advanced Computer Skills and Advanced Quickbooks Knowledge!!Client Service Representative is responsible for answering telephone inquiries of accounts, enrollees, and providers on matters pertaining to claims adjudication, enrollment, benefit interpretation, etc., utilize the telephone system equipment and the health claims processing system, PBM systems, in performance of assigned tasks. The representative assumes responsibility for the timely and accurate processing of inquiries in accordance with corporate guidelines pertaining to coverage, payment, quality and productivity. This position serves as a first point of contact for all clients/vendors contacting the organization to provide world class client service.Responsibilities: Communicate, interface, correspond, address, and follow up in response to general service needs, claims processing and information requests using electronic and written means which may include phones, fax and e-mails, with various points of contact including but not limited to clients, pharmacies, pharmacists, hospice agencies and vendors. Collect, troubleshoot and verify accuracy of data such as patient demographics, medication, names, strengths, quantities, etc. , from direct contact/calls/faxes/emails for input into claim processing system to allow claims to process appropriately and provide timely resolution and follow-up to claims processing issues as they arise. Contact and document pharmacy contact information which may include phone/fax numbers, address, hours of operation, pharmacy manager names and use internet tools to determine distance to/from client location. Provide information, as requested or needed, to clinical pharmacists and other staff, to assist in the accurate and timely completion of reports and med reviews for various clients. Document and provide accurate record of work performed on projects and their status. Provide daily/weekly reports to clients or management as necessary. Maintains quality standards and a professional image, as determined by management. Adhere to all company policies and federal and state regulations in accordance with company training. Initiate and maintain a good rapport with internal and external clients. Achieve departmental goals and performance standards. Communicate to management any workflow problems or abnormalities, issues or backlog immediately. Continually foster a team work spirit and maintain a neat working environment. Engage in career and professional development, opportunities and programs. May require the ability to work evenings, nights or week-ends or on-call and overtime. Prioritize and organize assigned work and assume responsibility for special projects, assignments and other related duties as required or assigned. Maintain confidentiality as required by HIPAA (Health Information Portability and Accountability Act) and PHI (Personal Health Information).
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