Participant Services Representative

This position involves extensive member contact via the telephone
Handles inbound/outbound calls from participants and/or prescribers when needed to start and process order requests
Ability to research and investigate orders using PeopleSafe and LINKS
Research issues sent by Customer Care, Account Managers, internal customers and Quality Assurance relative to the customer service experience
Notifying requestor of decisions, changes, or other relevant information pertaining to request/inquiry
Follow through on standard operating procedures, problem-solving and troubleshooting within guidelines
Ability to work under strict turn-around-times.

Position Summary:

Tasks for Customer Service Rep can differ per location: Effective delivery of company products and services (40%)
• Responds to telephone inquiries and orders from homecare patients and referral sources.
• Provides information on equipment, supplies and services
Determines the best method for providing services.
• May assist walk-in patients with the selection of equipment, supplies and services
Timely processing/facilitation of patient orders (30%)
• Processes telephone orders by preparing patient paperwork.
• Verifies insurance and/or other method of payment.
• Completes all necessary paperwork in an accurate and efficient manner to facilitate the data entry, accounts receivable and delivery of the order placed.
• May perform data entry.
• Distributes copies of paperwork to appropriate personnel.
• May assist with the processing of billing paperwork
Effective coordination of patient services/supplies (10%)
• Coordinates the delivery, set-up and pick-up of equipment, supplies and services with appropriate personnel.
• Ensures deliveries and set-ups can be arranged in a timely manner
Appropriate documentation (10%)
• Accurately maintains files of all patient account profile information and referral source data
Customer satisfaction (10%)
• Resolves patient complaints by identifying problems and coordinating appropriate corrective action.

Duties:

Knowledge of Medicare, Medicaid, and 3rd party vendors is a plus
The primary responsibilities are to verify insurance coverage for potential new clients
Additionally, this person will re-verify insurance coverage for existing patients in order to process patient prescription needs successly and demonstrate excellent customer services to patients, healthcare professionals, and insurance carriers
This role will require an understanding of insurance concepts, including drug cards, major medical benefits, and per diem coverage, as well as knowledge of government and patient assistance programs
Strong attention to detail, and proven analytic and problem solving.

Experience:


• Minimum of 1 year in a customer service or call center environment (call center type environments preferred, if doctors office then anything below managing 75 calls/day would not translate to similar environment).
• Must have effective and empathetic communication style in managing inbound calls and communications with clients and team members.
• Computer experience is required with proficiency in Microsoft Outlook, Word and Excel.
• Basic alpha number data entry skills with attention to accuracy and quality is essential.
• Intermediate math skills are required with attention to detail and quality essential.
• Experience in a health care setting or insurance industry is a plus, including knowledge of basic insurance and third party terms and medical terminology.
• Ability to work with people in a team environment while meeting individual performance goals.
• Must be able to read and interpret policies, procedures and instructions.
• Effective organizational skills and ability to prioritize a fluctuating workload and competing priorities is essential.

Education:

Verifiable High School diploma or GED is required.