Brief Job Description
- Promotes favorable relationships with members, providers, and health plans through the prompt, accurate and courteous resolution of issues;
- Receives and responds to customer inquiries (telephone, written and electronic) that may pertain to all phases of CPMG operations, including authorizations, claims inquiries and provider network access;
- Documents all customer contacts, including resolution or action taken to refer question to proper entity;
- Assists and educates member families with navigation of HMO processes.
The position will also include data entry/processing of authorization requests, including verification of benefits, research of authorization history, provider notes, use of correct CPT/ICD-9 codes, and providing referrals within CPMG network. Working collaboratively with all professional entities relating to CPMG business will be required, as well as assisting colleagues as necessary on special projects with time-critical deadlines.
Minimum Job Qualifications (education, experience, certification, skills, etc.)
- High school degree or equivalent education with computer keyboarding skills.
- Three (3) years experience working with health plans/healthcare.
- Excellent verbal and written language skills to answer customer concerns in simple, understandable language.
- Previous customer service experience in a physician office, hospital, or other healthcare setting.
- The ability to work both independently and as part of a team, maintain confidentiality, and exhibit a professional demeanor.
Preferred Job Qualifications
Knowledge of health plan benefits, claims, ICD-9/CPT coding.