What are the responsibilities and job description for the Customer Service Representative position at Desert Oasis Healthcare?
The Customer Service Representative will answer phone calls, e-mails, and correspondence. The Customer Service Representative will be responsible for meeting with “walk in” customers regarding claims issues and collaborate with claims examiners to resolve issues and communicate the resolution to the customer in a courteous and timely manner.
Professional Duties
Professional Duties
- Handles all incoming calls, inquires or concerns from providers, members and/or health plans. Seeking resolution and follow-up within 24 hours timeframe and documenting pertinent information into the system in order to track inquiries.
- Assists the claims department in achieving compliance with timelines for misdirected claims.
- Performs timely research and uses appropriate resources, which includes but is not limited to UM for referrals and contract verbiage, in problem solving to achieve a satisfactory disposition.
- Prepares documentation necessary for adjustments.
- Assists with audit preparation, as needed.
- Remains abreast of all Health Plan DOFR’s administered by DOHC claims department including but not limited to HMO, PPO, Private, Medicare and Medi-Cal. Verifies insurance benefits and co-pays, as needed.
- Verifies member’s eligibility and benefits with the eligibility and benefit department, as needed.
- Assists with workflow of medical records through Encore.
- Educates Providers and members on the correct claims processes and workflow, as needed.
- Performs other duties as assigned.
- Serve as an ambassador for Desert Oasis Healthcare and Family Hospice Care at all times and positively shape the customer experience
- Be an active listener (make eye contact, validate)
- Address customers as Mr., Mrs., or Ms. until invited to do otherwise. Never use terms of endearment such as hon, dear, sweetie, etc.
- Demonstrate appropriate body language and tone of voice
- Answer all phone calls with a salutation, introduction and offer to assist (Good afternoon, Desert Oasis Healthcare or Family Hospice Care, this is (your name), how may I help you?)
- Speak positively about your work, co-workers and Desert Oasis Healthcare and Family Hospice Care
- Avoid gossip and negativity
- Offer to answer any additional questions that the person, patient or customer may have
- High School diploma or equivalent required.
- One year experience in the medical or healthcare related field required.
- Knowledge of Medicare rules, medical terminology, and managed care health plan rules and regulations, ICD-10, CPT and RVS codes.
- Must type 40 wpm.
- Ability to manage time effectively and prioritize tasks to meet established deadlines.
- Ability to communicate effectively with individuals within all levels of the organization, patients, providers, vendors and others.
- At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.
- Sitting: Approximately 70% of day
- Standing: Approximately >25% of day
- Walking: Approximately >25% of day
- Lifting: 0 - 10 lbs (equipment, supplies) - approximately >5% of day
- Bending: Approximately >10% of day. Kneeling > 20% of day
- Hearing/Visual Acuity: Adequate for use with computers and telephone/mobile device - Approx 50% of day
- Computer: Highly technical work environment - Must be able to work 6 hours / day using keyboard, mouse and monitor
- Reaching: Above head 75 degrees - approximately 55%.
- Hand grip dexterity: Approximately 55% of day