Job description

Under close supervision, the Customer Service Specialist (CSS) is responsible for the effective and thorough handling of telephonic inquiries from all B&T customers. Accurately responds to inquiries on B&T policy regarding: claim status and adjustment, authorization and referral, eligibility, network composition, access and quality of care. Works with other B&T departments in the resolution of all customers inquires in a timely manner. Tracking of all inquiries and appropriate follow-up are required.

Qualifications

• 100% REMOTE - MUST RESIDE IN CALIFORNIA
• Required Education: High school Diploma or G.E.D.
• Minimum Experience: 3+ years customer service experience in a medical / healthcare call center environment
• Claims / Referral Services experience
• Epic/EMR Experience
• Customer Service Phone Queue Experience

Job Duties & Responsibilities

• Responsible to answer inbound and outbound calls for Claims, Customer Service and Referral Services department ACD queues; ensures that all telephonic inquiries are resolved satisfactorily and maintains professional and considerate relationships with all B&T customers both internal and external striving for excellent customer service; conveys confidence and expertise through the utilization of appropriate reference materials when answering all inquiries; listens attentively to customer issue(s) and deciphers customers’ needs to resolve in a competent, professional and thoughtful manner.
• Coordinates with internal and external sources to obtain necessary information to resolve customer issues creatively; escalates issues as appropriate to Lead, Supervisor or Manager.
• Provide education and assist in trouble shooting to offices related to enrollment and appropriate use of BTCare, eFax and submission of clinical notes; solves problems creatively while consistently maintaining professionalism in all customer (internal and external) interactions.
• Functions as part of a team contributing to the goals of the department with a positive and professional manner; works in a rotation with peers to provide coverage for the Front Desk based on schedule determined by leadership.
• Meets or exceeds all established production and quality standards; adheres to assigned schedule and manages time off effectively and is compliant with the absence and tardiness policies as outlined in the employee handbook.
• Must be able to research complicated issues and follow up with providers or members within the established turnaround time measures.
• Assist the team with the management of the “contact us” portals on Brown & Toland website and respond to member inquiries within established turnaround time; triage of all incoming faxes to the Customer Service fax line based on schedule determined by leadership.
• Support of company initiatives related to AHA health fairs and Open enrollment meetings. Attend a minimum of 1 event per year.

Knowledge, Skills & Abilities

• Proficient computer skills including Microsoft Office (Word, Outlook, Excel, PowerPoint).
• Use independent judgment and initiative within established policies and procedures.
• Ability to Interact and maintain excellent relationships with internal and external contacts to support compliance and high levels of service.
• Be an Ambassador for Brown & Toland and create a positive customer experience by utilizing your skills in Superior oral and written communication skills. Use a professional approach at all times to problem resolution, strong organizational skills, ability to prioritize projects, and maintain an excellent attendance record.
• Understanding and application of ICD-10, RVS, CPT codes, basic medical terminology and systems experience is required.
• Knowledge of medical terminology, enrollment and membership activities and claims processing procedures/systems is required.
• Ability to work as an effective team member recognizing the need for a positive manner at all times.
• Solves problems creatively while consistently maintaining professionalism in all customer (internal and external) interactions.
• Must be able to communicate with internal and external customers at all levels of management.
• Must be able to handle escalated communication professionally and efficiently

Job Type: Full-time

Pay: $21.00 - $24.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Work from home

Schedule:

• 8 hour shift

Education:

• High school or equivalent (Required)

Experience:

• Healthcare Customer Service Call Queue: 3 years (Required)
• EMR/Epic: 2 years (Required)

Work Location: Remote

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