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- Middletown, RI 02842
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Customer Care Associate
American Cybersystems, Inc. (ACS Group) • Middletown, RI
Posted 15 days ago
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ACS group has an immediate need for a Customer Care Associate with experience in the Healthcare Industry. This is a 3 months’ contract to hire opportunity and is located in Middletown RI 02842. Our client is a leading Healthcare organization.
Please review the job description below:
Job Profile Summary:
· This position is a frontline service position providing assistance to members and providers regarding programs, policies, and procedures.
· Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers.
· Responsibilities also include the administration of intake documentation into the appropriate systems.
· Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call.
· Performance expectations are to meet or exceed operations production and quality standards.
· Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
· Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
· Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
· Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
· Assist in the mentoring and training of new staff.
· Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).
· Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
· Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and achieve its business and operational goals.
· Educates providers on how to submit claims and when/where to submit a treatment plan.
· Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
· Informs providers and members on appeal process.
· Lead or participate in activities as requested that help improve Care Center performance, excellence and culture.
· Links or makes routine referrals and triage decisions not requiring clinical judgment.
· Performs necessary follow-up tasks to ensure member or providers needs are completely met.
· Provides information regarding in-network and out-of-network reimbursement rates and states multiple networks to providers.
· Refers callers requesting provider information to Provider Services regarding professional provider selection criteria and application process.
· Refers patients/EAP clients to the Care Management team for a provider, EAP affiliate, or Facility.
· Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
· Support team members and participate in team activities to help build a high-performance team.
· Thoroughly documents customers’ comments/information and forwards required information to the appropriate staff.
· HS Degree/GED
· Minimum 6 months – 1-year call centre experience (pharmacy/specialty pharmacy preferred) – REQUIRED
· CPT - PREFERRED
· Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting - PREFERRED
· Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite – PREFERRED
· Excellent written and verbal communication skills.
· Ability to follow clinical criteria and instructions to approve prior authorization requests.
· Ability to identify and trouble-shoot problematic issues.
Schedule: Monday-Friday 8:30am-5:00pm.
· This is not a typical clinical role.
· This is a CALL CENTER position, primarily outbound calls.
If it creates an interest for you, please email me the latest copy of your resume.
Thanks and regards,
T: 678 – 606 - 0205
ABOUT ACS GROUP. – ACS Group is a premier provider of IT Consulting, Engineering Consulting, Healthcare Solutions, Talent Solutions, and Workforce Management Solutions to Fortune 1000 companies globally. ACS Group conducts business through four operating brands – AIC, Analysts, ComforceHealth, and HireGenics – each with a specialized business focus. Our operating brands have provided targeted services and solutions for more than 50 years. Recognitions include: #1 Fastest Growing Company in the State of Georgia (2014); Ranked by SIA as the Second Largest Minority-Owned IT Consulting Company in the U.S. (2015); and winner of Inavero’s Best of Staffing® Client Diamond Award (2016). ACS Group is a certified MBE organization, and an NMSDC Corporate Plus® member, headquartered in Atlanta, Georgia, with offices across the U.S. and India, and an international presence in Canada and Latin America.