Overview

Identify the need(s) of the referring source and/or patient by collecting all necessary data relevant to that need; interpret, verify and process that data to determine if patient is eligible; and facilitate the initiation and termination of the care and services provided in a timely manner. Respond to customer issues that may arise during and after order processing. Actively engages and coordinates with other team members to maintain a positive, collaborative relationship. Works under close supervision.

Responsibilities

In this role you will:

• Work closely with health plans/payers and maintains strong business relationships.
• Provide appropriate issue resolution and/or escalation when needed. Works under moderate supervision, with clinical oversight.Receive and respond to incoming calls or faxes from providers, referral sources, and potential patients.
• Enter information to begin the referral process into the CareCentrix portal and accurately records the outcome of calls in the proper screen.
• Collect and enter clinical and demographic information to begin the referral process along with verifying eligibility and benefits information by contacting health plans or payors to ensure services provided will be covered by the carrier. (e.g., deductible amounts, co-payments, effective date, pre-existing clauses, levels of care, authorization, visit limitations, documentation required to process claims, etc.).
• Document all communications and decisions into a computer database.
• Consult applicable Payer Fact Sheets in Intake Process. Work with other staff and patients to identify potential solutions as problems are identified with payer sources.
• Identify potential payer sources, obtains authorization from the authorizing entity. Accurately documents conversations and decisions with payer sources.
• Processes SV Alerts and communicates resolution to the quality team and the patient.
• Log all interactions and thoroughly following up with members and providers.
• File CARTs, completes the Internal Issue Log, and SOC templates when applicable.
• Master the Intake/Verifications function as a second function; Staffing as back-up and learns two health plans.

Qualifications

You should reach out if you have:

• A High School Diploma or the equivalent
• Minimum 1 year work experience in customer service
• 1 year billing, insurance or claims experience
• Experience with Medical terminology, insurance verification or healthcare experience preferred
• Proficiency and are comfortable in a computer-based environment
• Values of accountability, consistency, engagement, patient compassion, empowerment, respect and outstanding service
• Excellent communication, customer service and problem solving skills, as well as the ability to effectively interact with all levels of management and highly diverse customers
• Strong organizational skills and be extremely detail-oriented
• Critical thinking and the ability to analyze data to understand an expected outcome

What we offer:

• Starting Pay for external hires is $16.50 / hour + Monthly Incentive Bonus Opportunity. The pay range included in this posting reflects future growth / earning potential.
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more
• Advancement Opportunities, professional skills training, and tuition /exam reimbursement
• PayActiv - access earned income in between pay checks
• Walgreens Discount - receive up to 25% off eligible items
• Great culture with a sense of community

CareCentrix maintains a drug-free workplace

#IDCC

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.