Job Description
Summary:
To serve as a liaison between IPA and its Members and Providers. Ensures that all Members and Providers receive a level of service that exceeds their expectations. Respond to and resolve questions and problems from current Providers/Members, or their representative and other appropriate parties.
Duties and Responsibilities:
Be proficient in discussion and execution including, but not limited to, the following:
· Multi-Task in a very busy Call Center Environment
· Explanation of how the plan works and how to utilize the service
· Explanation of the Claim process, payment, denials, etc.
· Explanation/Assist with Benefit clarification, eligibility, verification, and claim status
· Participate as a team player by demonstrating support to peers, management, and the department's goals
· Attend meetings and training sessions as scheduled
· Assist with training new employees as needed
· Show flexibility in meeting performance objectives consistent with IPA and department objectives
· Document all Provider/Member inquiries and complaints in appropriate systems and either handle, redirect, or defer to the appropriate department for resolution.
· Proficiently review and respond to Web Portal Inquires for Claims related issues through the portal.
Minimum Job Requirements:
· High school diploma.
· Two years of Customer Service/Telemarketing sales or related experience.
· Knowledge of Medi-Cal, Managed Care plans, CPT Codes, ICD-10
Skills and Abilities:
· Must be computer literate, typing 30 wpm
· Excellent telephone techniques
· Excellent interpersonal and communication skills; strong writing skills
· Medical Front and Back Office as well as Claims/Billing experience preferred
· Bilingual in Spanish preferred