What are the responsibilities and job description for the MEDICARE CLIENT SERVICES REPRESENTATIVE position at VIVANT HEALTH LLC?
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
- Two (2) years of call center experience required
- One (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.
