Concierge Customer Service Representative II

· Respond to telephone and email inquiries received from members and provider within defined service standards.

· Negotiate with providers to gain acceptance for plans without network agreements and/or out of network providers.

· Assist members with benefits and healthcare questions.

· Document all calls received in system-based call log.

· Handle all incoming MedWatch precertification calls (i.e., start cases, do call logs, forward calls, provide case status, provide claims phone #’s, etc.)

· Make outgoing calls for MedWatch (demos, information for case completion, re-direction for network steerage, etc.)

· Complete incoming electronic Web-certs.

· Verify patient and provider demos – correct and/or complete when needed.

· Strong customer relations, interpersonal skills.

· Strong appreciation and ability to handle confidential & sensitive information.

· Proficient with Microsoft applications, strong computer skills and computer navigation.

· Excellent data entry and typing skills.

· Knowledge of provider organizations and networks.

· Knowledge and understanding of CMS Medicare reimbursement rates.

· Ability to effectively negotiate rate structures.

· Patience and ability to handle difficult situations tactfully and diplomatically.

· Takes initiative to resolve situations and to accomplish projects actions and tasks.

· Excellent verbal and written communication skills.

· Independent judgment in decision making and problem solving.

· Ability to multi-task & anticipate potential needs/problems.

· Ability to build relationships with internal and external customers.

· Medical Terminology

· Strong attention to detail.

· Understanding of Self-Funded health benefits a plus.

· Health Payor background preferable in self-funded industry a plus

· Claim processing skills a plus.

· Insurance verification or pre-certification a plus

· Provider office/facility billing department or financial area

· TPA experience a plus.

· Strong analytical and research skills

· Bilingual a plus

· Associate degree or higher preferred but not required, Minimum High School Diploma or G.E.D.

· Two Years Customer Service / Call Center experience in a health care related role.

· Medical Intake experience a plus

The pay range for this position is $19.00 to $20.00 hourly.

Work Environment / Physical Demands: This position is in a typical office/home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients.