Job Description

The following statements are intended to describe the general nature and level of work to be performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of an incumbent.

POSITION SUMMARY

VAST (Verification, Authorization & Surgical Team) Customer Service Professionals (CSP’s) are responsible for supporting client retention and PT referral objectives by consistently providing an easy, efficient and productive customer experience for callers, by attempting to obtain authorization, surgical clearance & related communication back to the adjuster or nurse case manager in a timely manner. Productivity and quality of work are of equal importance.

ESSENTIAL RESPONSIBILITIES & DUTIES:

1. Make outbound calls to MD and patients to confirm surgery clearance for cases in Surgical Queue status
2. Request verification from insurance companies and other related paperwork telephonically/electronically for cases in Referral QA Queue status
3. Make outbound telephonic/electronic contacts with adjusters and Physical Therapy Centers to verify new case information/missing information and request other related paperwork.
4. Communicate with adjusters and nurse case managers regarding updates on patient status in a timely manner.
5. Consistently meet VAST Productivity & Quality standards (call monitoring and EOC monitoring) daily/monthly.
6. Validate new case data by reviewing, correcting, deleting, or re-entering data; combining data when account information is incomplete; purging files to eliminate duplication of data.
7. Maintain accurate daily spreadsheet
8. Communicating all coaching opportunities/findings to Supervisors/TL’s
9. Understand MedRisk’s interdepartmental procedures, policies and comply with them.
10. Identify potential or existing system and/or procedural challenges, and notify Supervisor and assist in resolution if needed.
11. Complete special projects or tasks as assigned by the supervisor.
12. Apply knowledge of and adhere to the URAC Utilization Management Standards.
13. Other duties as assigned.

QUALIFICATIONS

MINIMUM FORMAL EDUCATION:

Bachelor’s degree strongly preferred

MINIMUM WORK EXPERIENCE:

Minimum of 3 years of call center experience with both in-bound and out-bound calls (medium to high volume).

Prior  experience  in  health-related  field  and  some  knowledge  of  medical  terminology/coding  i.e. CPT/HCPCS and ICD9 experience a plus, but not required

SPECIAL SKILLS/CERTIFICATIONS:

High level of self-motivation

Excellent verbal and written customer service skills demonstrating a can-do attitude. Highly developed problem-solving skills.

Strong data entry skills

Detail oriented and solid organizational skills

Solid MS Word, Excel and Outlook experience

Must have ability to multi-task and work independently

Bilingual in English and Spanish is a plus, but not required