MEDICARE CUSTOMER SERVICE REPRESENTATIVE

Job Summary:

The incumbent will be required to accept incoming calls at a very rapid pace, problem solve any challenges presented with claims, authorizations for service, and various other issues. 

Responsibilities:

• Receive inbound calls from patients requesting status updates and information on Claims, Authorizations for Service, Eligibility for Service, and various other related Medical questions.
• Works collaboratively with Advance Medical Management (AMM) Team.
• Assist AMM Care management nurse by coordinate post hospital or Emergency Department (ED) transition of care.
• Assist AMM Quality Management Coordinators by assisting with outreach for Annual Wellness Exams (AWE) and GAP closures.
• Conduct outreach calls for Medicare Advantage members for the purpose of onboarding them to Vivant Health (Member Engagement).
• Conduct outreach calls to members becoming eligible for Medicare for the purpose of inviting them to an onsite seminar.
• Provide information on eligibility for medical services.
• Transfer calls to appropriate departments when applicable.
• Identify, research, and resolve any issues regarding Claims, Eligibility, Authorizations for Service, etc.
• Make outbound calls for follow up purposes when needed.
• Recognize and alert management of inappropriate trends in customer calls
• Represent Vivant Health at onsite events and coordinate in collaboration with Supervisor.
• Recommend process improvements
• Regular attendance.
• Travel as required.

Other Functions

• Enforces Company policies and safety procedures.
• Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
• Maintain IPA, Health Plan compliance standards.

Competencies

• 2+ years of call center experience required
• 1+ year in medical or healthcare environment required
• Working knowledge of Medicare Health Plans strongly preferred.
• Strong oral and written communication skills, with the ability to communicate professionally with diverse individuals and groups inside and outside of Vivant.
• Excellent active listening and critical thinking skills.
• Ability to consistently deliver excellent customer service
• Consistently exercise sound judgment, and strict maintenance of confidentiality.  
• Proactively and effectively solve problems.  
• Collaboration with others, and development of partnerships and good working relationships.  
• Ability to work independently as well as in a team environment.
• Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
• Excellent attention to detail and ability to document information accurately.
• Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
• Ability to demonstrate professionalism, confidence, and sincerity in a diverse work culture.
• Ability to provide and receive constructive job and/or industry related feedback.
• Demonstrate commitment to the organization’s mission.
• Ability to present self in a professional manner and represent the Company image.
• Must have mid-level skills in MS Word and MS PowerPoint.
• Must have the ability to quickly learn and use new software tools.
• Must have mid-level skills using e-mail applications.

Education and Licensure

• High School Diploma or GED minimum required

Travel

• The incumbent may travel up to 5% of the time.

Work Environment

This job operates in a professional office environment.  This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.