Customer Service Representative

Identifies, researches, and resolves customer issues; Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance.
Maintains confidentiality; Listen to others without interrupting; Keeps emotions under control; Remains open to others’ ideas and tries new things.
Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds quickly and effectively to customer questions.
Multi tasks to document while speaking with the consumer.
Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Meets clients’ specific quality standards.
Meets productivity and sales standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.

Answers inbound member and provider calls related to health plan questions.
Coordinates with other departments to effectively resolve any customer complaints or concerns.
Adheres to department policy and procedures including but not limited to call statistics, goals, and department deadlines.
Responds to and completes Web/electronic/mailed Member inquiries.
Completes overflow and after-hours customer service inquiries.
Assists in compiling and mailing Member packets
Assists in outbound test calls to Interpreters and TTY/TDD
Assists with the Customer Loyalty Management (CLM) and Primary Care Physician (PCP) programs.
Assists in Member outbound retention calls
Assists with department audits
Assists in the handling of Complaints, Appeals, and Grievances
Maintains confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.

Performs account follow-up on outstanding insurance balances and takes the necessary action for account resolution in accordance with established federal and state regulations.
Contacts all assigned accounts in the work queue daily and provide sound collection follow-up on outstanding insurance balances.
Batches, compiles, submits appeals and monitor accounts for proper reimbursement.
Responsible for achieving and maintaining accounts receivable days at the established goal.
Establishes and maintains effective communication with employers, other healthcare providers, insurers, and patients/families to secure accurate and pertinent information to maximize reimbursement.
Communicate with internal and external customers by telephone and mail to verify charge accuracy and/or correct account errors.
Monitors and tracks contractual, billing, registration, and posting errors and provides continuous feedback to the department supervisor.
Verifies applicable contract by reviewing EOB messages, reviewing patient ID card, and verifying member information for managed care plans.
Uses good interpersonal skills to promote positive, effective interaction with customers and to promote quality service to ensure flow of information to appropriate staff and professionals.
Provides detailed documentation on the collection system to explain the action taken or promise made. Obtains current information on all accounts and records information as required.
Performs miscellaneous job related duties as requested.

Obtain all information needed to determine claim type and program codes necessary to review, enter and process claims to determine covered benefit or patient responsibility.
Provides efficient and effective service to customers and prospects to a variety of inquiries and customer needs.
Understands customer needs, determines the appropriate course of action to meet those needs and completes or initiates the transaction.
Exercises independent thinking in meeting customer/employer expectations.
Ability to handle routine customer transactions.
Ability to work under time constraints.
Ability to understand and apply new concepts.
Ability to analyze information and evaluate results.
Ability to effectively deal with complex customers.
Demonstrates a commitment to learning quickly and effectively applying knowledge as well as supporting/creating a productive, positive work environment.
Attention to detail-documentation and follow-up

Oversaw all administrative duties in an office in order to ensure efficient and smooth daily operations.
Managed inventory of both office and warehouse.
Primary point person for maintenance, mailing, shipping, supplies, equipment, bills, and errands.
Played an essential role in the hiring, onboarding, and training of staff; as well as being responsible for job assignments, employee scheduling, and payroll.

Upheld all CPR and state regulated certifications
Documented patient interactions and conducted safety rounds to ensure patient safety and security.
Communicated effectively with patients to maintain excellent customer service.
Assisted team members in verbal and physical interventions when needed to ensure the safety of patients.
Provides direct care and supervision for residents
Assures residents are kept safe, learn and practice appropriate hygiene and self-help skills, and are aware of rules and expectations.
Acts as a role model for residents, demonstrating effective problem-solving and decision-making skills.
Assists in providing recreational and therapeutic activities for the residents, transporting residents to and from medical appointments, and assuring scheduled programming is carried out.
Performs duties as assigned by the Nurse Manager and Milieu Coordinator.

Performed duties as assigned by the Nurse Manager and Milieu Coordinator.
Upheld all CPR and state regulated certifications
Documented patient interactions and conducted safety rounds to ensure patient safety and security in compliance with HIPAA requirements.
Communicated effectively with patients to maintain excellent customer service.
Assisted team members in verbal and physical interventions when needed to ensure the safety of patients.
Provided direct care and supervision for residents
Assured residents were kept safe, taught and practiced appropriate hygiene and self-help skills, as well as fully aware of all rules and expectations.
Acted as a role model for residents, demonstrating effective problem-solving and decision-making skills.
Assisted in providing recreational and therapeutic activities for the residents.
Accompanied residents to and from medical appointments.
Provided excellent service to patients through personable communication.
Supported patients in identifying and addressing mental health challenges.
Cultivated relationships with patients, discussing ways to help improve overall health while alleviating self-harm practices.
Assisted team members in verbal and physical interventions as needed to ensure safety of patients.

Verified final claim submissions by comparing account charges with documentation.
Performed with precision by accurately entering data and researching background information to resolve refund questions.
Submitted claims to insurance companies. Completed, filed and submitted appeals.
Assessed medical codes on patient records and prepared invoices to be submitted to insurance companies.
Reconciled codes against services rendered.
Applied HIPAA Privacy and Security Regulations while handling patient information.