Jobs

Description

Responsibilities:

• Makes outbound validation calls to providers in order to assure of demographic practitioner detail for each practice location for all Client networks.
• Contacts members regarding preventive health activities.
• Receives inbound services calls and provide accurate complete information in response to provider inquiries, complaints and problems within a timely fashion.
• Contact provider offices to encourage ongoing education and dialogue on data management best practices to service member/patient needs and to attend scheduled orientation sessions and other educational and outreach activities.
• Conducts provider surveys and assessments as applicable.
• Act as liaison with providers, members and outside community resources.
• Handle PCP/PCD changes for members.
• Verification of PCP/PCD and member eligibility with Providers.
• Maintain call documentation in databases with relevant information regarding special outreach projects in accordance with departmental focus and objectives.
• Assist provider offices with issues associated to credentialing, recredentialing, claims and provider data maintenance by providing guidance on how to proceed with the process.

Job Qualifications

• Education/Experience: High School Diploma/GED required.
• Requires a minimum of 3 years of experience in customer service, telephone sales preferably in a Managed Care environment.
• Some experience with provider practices, physicians and/or office managers in a healthcare, group practice setting.

Knowledge:

• Prefers knowledge of Client products and services
• Requires knowledge of health insurance industry
• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes
• Should be knowledgeable in the use of intranet and internet applications.

Skills and Abilities:

•  Requires excellent oral and written communication skills.
• Requires strong interpersonal and organization skills.
• Requires ability to resolve problems.