Specialized Recruiting. Temporary Staffing. Managed Services. 800 876 2314


Medical Service Support Representative (Call Center)

Employment Type Permanent
Field of Work Customer Support

 

Position Summary

The Medical Service Support Representative is responsible for providing administrative, telephonic and support tasks involved in the day-to-day activities related to the work that is conducted by or in conjunction with the Medical Directors. The Medical Service Support Representative will work closely with the departments, to ensure the timely completion of all medical director reviews. As a non-clinical staff member, the Medical Service Support Representative will be responsible for providing timely and effective customer service to clients and customers (internal/external) in accordance with the departmental and organizations standards.

Primary Responsibilities

  • Provide telephone support to external Provider Health Plan staff as well as to internal programs.
  • Develop and maintain a professional relationship with the support staff, of Medical Directors, and Consultants.
  • Develop and maintain professional relationship with internal and external provider offices and managed care personnel.
  • Coordinate the Medical Director Reviews and Appeals between the Correspondence; Claims, and Medical Services departments to ensure that all information is received, recorded and filed in the appropriate and timely manner.
  • Accurately, enter and maintain information in various databases.
  • Participation in training classes related to Confidentiality, Conflict of Interest, HIPAA, URAC and department specific training as applicable.
  • Answer incoming calls promptly and in a professional manner.
  • Meet or Exceed Service Level/Quality and Compliance targets as set forth by the department and/or organization.
  • Maintain updated and accurate information in conjunction with the calls that come through the Medical Director telephone line and document all inquiries and results in the Customer Service System.
  • Obtain accurate information from the caller; accurately document the telephone interaction.
  • Schedule appointments for Medical Directors to support various programs.
  • Follow-up on inquiries, complaints etc. via email and/or telephone as required.
  • Direct calls to other departments, and/or external providers as required.
  • Provide assistance with mailings.
  • Utilize active listening/good judgment to determine when to escalate a call to a clinician, business operations staff member.
  • Strong ability to multi-task in a fast paced environment.
  • All other duties as assigned.

Position Requirements

  • Associate's required; Bachelor's degree preferred.
  • ICD9 CODING Certificate preferred.
  • One-to-two years administrative and/or call center experience in a healthcare environment.
  • Pleasant, professional demeanor: articulate customer service individual.
  • Medical office experience preferred.
  • General knowledge of the medical environment: managed care benefit plans NCQA and URAC standards and guidelines, eligible requirements; etc.
  • Strong ability to communicate effectively and professionally and exercise good judgment.
  • Ability to handle confidential and sensitive information.
  • Knowledge of Windows, Microsoft Word, Excel, Database (Setup Files).
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