Customer Service Representative I

This position is responsible for answering telephone calls in a prompt, courteous, professional manner and acting as a liaison between Prospect Medical/ProMed Healthcare and: members; contracted and non-contracted care providers, ancillary providers; health plans; billing companies; collection companies, to provide assistance and respond to service requests.  Representative is responsible for being a resource for other team members..

• Assist customers on the telephone with inquiries, updates, changes related but not limited to claims, eligibility, referrals, PCP changes, billing, access, transportation and general coordination of care through thorough research in a timely manner. The monthly expectation is to perform at a quality level of 90% accuracy of all measures.  The daily expectation is to efficiently answer a minimum of 60 calls per day (inbound).
• 100% thorough documentation of every call.
• Thoroughly verify HIPAA requirements to ensure account accuracy.
• Follow-up on all open issues.
• Communicate recurring issues and trends to management.
• All other duties assigned. 

Minimum Education: High school diploma or equivalent.

Minimum Experience: A minimum of two (2) years of customer service experience in a call center environment required. Within a health care setting preferred. Ability to multi-task, prioritize, and work in a fast pace environment. Ability to multi-task, prioritize, and work in a fast pace environment. Knowledge of HIPAA regulations preferred. Knowledge of IPA operations in a health care setting preferred. Knowledge and experience of claims , eligibility, and referrals preferred. Must be proficient in Microsoft Office navigation, Excel, and Word and/or IDX knowledge.

Req. Certification/Licensure: None.

"Location-Based Pay Adjustment"