What are the responsibilities and job description for the Medicaid Customer Service Representative position at Leeds Professional Resources?
We are seeking a compassionate, professional, and detail-oriented Medicaid Customer Service Representative to assist Medicaid members with questions regarding eligibility, benefits, claims, coverage, providers, authorizations, and other healthcare-related services.
The ideal candidate will have excellent communication and customer service skills, the ability to handle sensitive member information with discretion, and experience working in a healthcare, insurance, Medicaid, or call center environment. This position requires patience, empathy, accuracy, and the ability to effectively resolve member concerns while adhering to applicable policies and regulations.
Key Responsibilities
Member Customer Service
- Respond to incoming calls and inquiries from Medicaid members in a professional and courteous manner
- Assist members with questions regarding benefits, eligibility, coverage, claims, and available services
- Explain healthcare benefits and policies in a clear and easy-to-understand manner
- Research member accounts and provide accurate information based on established guidelines
- Resolve member concerns and complaints promptly and professionally
- Escalate complex issues to supervisors or appropriate departments when necessary
Medicaid & Eligibility Support
- Assist members with questions regarding Medicaid eligibility and enrollment
- Provide information regarding plan benefits, coverage requirements, and participating providers
- Assist members with locating or selecting participating healthcare providers
- Explain changes to member benefits, coverage, or eligibility as appropriate
- Coordinate with state Medicaid agencies and internal departments when required
Claims & Billing Support
- Answer questions regarding claims, payments, deductibles, copayments, and covered services
- Research claim status and assist members with resolving billing-related concerns
- Communicate with providers and internal claims departments to resolve discrepancies
- Document all member interactions and actions taken
Provider & Authorization Support
- Assist members with questions regarding provider networks and covered services
- Help members understand referral and prior authorization requirements
- Coordinate with provider services and utilization management teams as necessary
- Assist members in resolving issues related to appointments, referrals, and authorizations
Documentation & Compliance
- Accurately document all calls, inquiries, complaints, and resolutions in the appropriate system
- Maintain strict confidentiality of protected health information (PHI) and member information
- Follow HIPAA, Medicaid, state, and company policies and procedures
- Ensure all member interactions are handled in accordance with established quality and compliance standards
- Meet established customer service, quality, and productivity metrics
Administrative Support
- Process member requests, demographic updates, ID card requests, and other account changes
- Assist with correspondence, forms, and documentation as needed
- Participate in training and ongoing education regarding Medicaid programs, benefits, and policies
- Maintain current knowledge of plan benefits, procedures, and customer service requirements
Salary : $19