Customer Service Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Develop and uphold a thorough understanding of the current products and services provided by the company.

• Respond to inbound calls and emails in a timely manner while also making outbound calls.

• Record call details in accordance with established operating procedures.

• Address inquiries regarding products, services, retail locations, and general service line information.

• Process orders, direct calls to the appropriate departments, and follow up on customer inquiries.

• Verify the accuracy of required documentation.

• Process, confirm, and/or submit necessary documentation and orders.

• Conduct insurance verification to ascertain patient eligibility, coverage details, co-insurances, and deductibles.

• Secure pre-authorizations when necessary and submit physician orders to insurance providers.

• Navigate various online EMR systems to gather relevant documentation.

• Input and review essential information in the EMR system, including authorizations and their expiration dates.

• Communicate with Customer Service and Management regarding trends observed with insurance companies.

• Ensure insurance carriers are accurately listed in the company database and request updates when necessary.

• Reach out to patients when documentation fails to meet payer guidelines, provide updates, and suggest options to facilitate referrals.

• Achieve quality assurance standards and key performance indicators.

• Address and resolve customer complaints and issues.

• Utilize company-provided resources such as Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI, PECOS, and instructional documents.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• A minimum of one (1) year of relevant experience in healthcare administration, financial services, insurance customer service, claims processing, billing, call center operations, or management in any industry.

• For senior-level positions, two (2) years of relevant experience is required alongside one (1) year of specific job experience.

• Proficient in computer skills with a solid understanding of Microsoft Office applications.

• Strong aptitude for learning new technologies and comprehending the flow of data within systems and their interactions.

• General familiarity with Medicare, Medicaid, and Commercial health plan methodologies, as well as documentation requirements, is preferred.

• Exceptional customer service abilities.

• Strong analytical and problem-solving skills with a keen attention to detail.

• Outstanding verbal and written communication skills.

• Capability to prioritize and manage various tasks efficiently.

• Ability to work both independently and collaboratively within a team.

• Flexibility and adaptability to thrive in a rapidly changing environment.

• Must demonstrate patience, accountability, proactivity, initiative, and effective teamwork.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with company match.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on work-life balance.