Job Description
Job Description
- Primary Purpose
To provide high-level customer service to PDTs’ clients with accuracy.
- Principal Duties and Responsibilities - *Goals on Performance Review
- Answer calls from members, providers, and health plans regarding specific claim issues. Route and redirect calls as necessary.
- *Return calls from the UM voicemail box within 24 hours
- *Perform timely follow-up on calls requiring research and call back within 24 hours.
- Accurately interpret DOFRs – Division of Financial Responsibility documents to determine where specific health care services are rendered.
- Verify eligibility & benefits for each submitted physician referral by contacting health plans for pertinent information.
- Work with contracting personnel to ensure the utilization of appropriate providers.
- *Provide requested referral and network information to providers/staff promptly within 24 hours.
- Use MedMC to log incoming calls and their resolution.
- Complete other projects as assigned by the supervisor
- Job Specifications (KSAs):
- Requires the ability to speak, read, write, and understand English and other general educational skills, as is generally obtained by completing high school or a GED.
- Knowledge of the health or managed care industry is generally obtained through 1-2 years of work experience.
- Excellent communication skills with a focus on superior telephone etiquette.
- 1-2 years of customer service experience required.
IV Position Performance Criteria
- Ability to organize and maintain multiple sets of information and data.
- Consistently produces accurate and timely work as it relates to departmental goals.
- Demonstrates high reliability through consistent punctuality and attendance.
- Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow-through.
- Uses sound judgment regarding time management and prioritization of work to balance multiple tasks and meet required timeframes for all administrative activities as required.
- Demonstrates excellent interpersonal skills as discerned through observation and team project successes.
- Accurately interprets and applies departmental policies and procedures using sound judgment.
- Communicates professionally and respectfully with peers, superiors, subordinates, and clients.
- Provides constructive feedback on assigned work projects.
- Demonstrates overall professionalism in attitude, demeanor, and personal appearance.