Title: Customer Service Specialist
Duration: 3-6 months
Working hours: 8:30am to 5:30pm EST or 10:30am – 7:30pm EST
Note: Training shift timming Schedule :
8:30am – 5:30pm EST or 10:30am – 7:30pm EST
OT needs: effective 01/03/2023
Choose from the following options:
7:00am to 8:30am EST (300 CW’s) or 5:30pm to 10:00pm EST (300 CW’s)
- Complete data entry from the enrollment form into the CRM.
- Complete electronic eligibility checks for payer and coverage details.
- Conduct a benefit investigation to determine plan coverage, payer restrictions, and cost share information from insurance plans.
- Identify if coverage restrictions exist, the process in which they are handled.
- Collect PA requirements, follow up with the insurance for prior authorization status, and communicate the results to the healthcare provider.
Under general supervision of an Operations Manager, the Benefits Verification Specialist will contact insurance companies to verify patient specific benefits for programs we administer. The Benefits Verification Specialist will ask appropriate questions regarding patient’s benefits and complete data entry and/or appropriate forms to document patient’s benefits coverage.
Primary Duties and Responsibilities:
1. Reviews all patient insurance information needed to complete the benefit verification process.
2. Triages cases with missing information to appropriate program associate.
3. Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options.
4. Identifies any restrictions and details on how to expedite patient access.
5. Could include documenting and initiating prior authorization process, claims appeals, etc.
6. Completes quality review of work as part of finalizing product.
7. Reports any reimbursement trends/delays to management.
8. Performs related duties and special projects as assigned.
Experience And Educational Requirements:
High school diploma or GED required. Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate’s degree program, technical vocational training, or equivalent combination of experience and education. Two years (2) + years directly related and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement.
Minimum Skills, Knowledge And Ability Requirements:
1. Proficient Windows based experience including fundamentals of data entry/typing
2. Working knowledge of Outlook, Word, and Excel
3. Strong interpersonal skills and professionalism
4. Independent problem solver, good decision maker, and robust analytical skills
5. Strong attention to detail
6. Effective written and verbal communication
7. Familiarity with verification of insurance benefits preferred
8. Attention to detail, flexibility, and the ability to adapt to changing work situations.
9. Strong customer service experience
The work environment characteristics described here are representative of those an associate encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
The noise level in the work environment is consistent with an office setting.
Physical And Mental Requirements:
The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
1. Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling, repetitive motions, talking and hearing.
2. Visual requirement is for close vision, distance vision, peripheral vision and ability to adjust focus.
3. 75% or more time is spent looking directly at a computer.
4. Ability to deal with stressful situations as they arise.
- Attention To Detail
- Business Administration
- Claim Processing