Customer account specialist

Job Summary / Purpose

• The Customer Account Specialist is responsible for verification and documentation of insurance benefits; insurance eligibility and customer out-of-pocket expenses;
• reviews all supporting medical documentation to determine if services will be covered by the insurance based on the diagnosis and the insurance coverage criteria for payment of medical items being provided;
• is a resource for customers and referral sources regarding insurance coverage and availability of medical items at GPRS;

facilitates all processes to assure customers receive the medical items requested, while maintaining a courteous and professional demeanor when helping customers.

Essential Key Job Responsibilities

• Calls insurance companies or accesses website portals to verify insurance benefits / eligibility.
• Assures insurance policy information is current and correct claims submission information is documented within the customer account.
• Reviews physician prescriptions to determine what items and services are being requested and contacts physician offices to request supporting documentation when needed.

Review all supporting documentation received to make determination of insurance coverage.

• Keys all initial orders for rental and supplies.
• Works with customer service to assure all resupply orders have appropriate prescriptions and customers are eligible to receive their resupply orders prior to dispense.
• Consistently demonstrates self-learning skills by keeping informed of payer rules and guidelines by reading journals, newsletters, articles, payer websites and emails.

Consistently available to patients and coworkers and have a willingness to train / educate coworkers, demonstrates patience, kindness, and professionalism at all times.

Research, review and respond to all verbal and written correspondence including e-mails as necessary to ensure timely response.

Uses professional skills when handling calls and inquires by patients and coworkers.

Demonstrate the ability to prioritize and organize workload and consistently volunteers to assist co-workers with their job duties when possible.

Maintain a direct line of communication between hospital, clinic and fiscal departments.

Must be self-directed; manages multiple tasks. Well-developed oral and written communication skills. Works in harmony and with a spirit of cooperation with physicians and the general public;

disciplined to actively listen to customer's needs and takes responsibility to address those needs. Thrives in a fast-paced work environment.

Qualifications

High school diploma required. Associates degree in a related field preferred, but not required. Two years of experience in customer service is preferred.

Job Posted by ApplicantPro

Last updated : 2024-05-01