Call Center Rep

Title : Call Center Rep
Duration: 3 months
Location: Houston TX 77086
Schedule: Candidates must be able to work an 8 hour shift during the department operation hours which are 7am-6pm Monday-Friday

Duties:

• To serve as a Member and/or Provider Advocate by possessing knowledge and understanding of the organization's processes, policies and procedures in order to investigate, resolve and/or facilitate resolution of simple to moderately complex issues
• and/or questions reported by client members, prospective members, healthcare providers, or other entities relating to client Managed Care Organization
• To be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals and/or any other Member/Provider needs.
• To assist and advocate for Members and/or Providers throughout the complaint and appeal process. To assist Members with timely appointment scheduling.

Responsibility A: Supports the Health Plan call center’s day to day operations
• Handles calls from Members/Providers seeking assistance with Member and/or Provider related issues. Reviews systems to identify issues, comprehensively researches the issues, collaborates with other departments, communicates with internal
and external resources, and creates appropriate responses.

• Acts as a liaison and advocate for the Members/Providers.
• Gathers information to support decisions or recommendations for action needed to resolve Member/Provider questions, issues, and/or concerns.
• Assists with real-time resource management.
• Interacts tactfully and empathetically with Members/Providers.
• Ensures HIPAA protections are in place by verifying the identity of all callers prior to disclosing Personal Health Information
(PHI).
• Completes all assigned work queue tasks and/or after hour call center vendor notifications.
• Completes necessary documentation thoroughly, accurately, and timely in TCHP or Client systems e.g. MACESS or EPIC when applicable.
• Alerts team leader of any issues or concerns that require escalation for complete resolution or which may indicate a larger underlying problem.

Please have the candidates answer the questions below and attach them to the resume.

Provider Hotline – Recruiter Prescreen Questions

1. Do you have at least 1–2 years of call center experience supporting providers or medical offices?
2. Have you worked in a Medicaid or managed care health plan? If yes, in what capacity?
3. Do you have experience verifying member eligibility and benefits?
4. Are you familiar with Medicaid claims processing and remittance advice codes?
5. Have you supported providers with denied claims or authorization issues?
6. What experience do you have explaining appeals or reconsideration processes to providers?
7. Are you comfortable handling escalated provider calls regarding payment delays?
8. What systems have you used for claims or authorization review?

Required - 
Candidates must be able to work an 8 hour shift during the department operation hours which are 7am-6pm Monday-Friday

Skills - 
Knowledge of managed care, customer service, call center desktop support applications, and general computer literacy
• The ability to work well with the public and adopt a customer perspective and work well individually and in a team environment
• Effective interpersonal skills and phone etiquette are required
• Strong verbal communication skills
• Good listening skills
• Knowledge of medical terminology
• Problem identification and problem solving skills and able to multitask
• Technical Skills: Typing, 35 WPM
• Bilingual (English-Spanish) preferred