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Posted : Tuesday, September 12, 2023 02:56 PM
*Job Description *
*Job Title: * Customer Service Specialist *FLSA Classification: *Non-Exempt
*Department: *Customer Service *Rev Date: *06/20, 1/21
*Reports To:* Customer Service Manager or Supervisor *Approved by: *Human Resources
*Position Summary: *
Customer Service Specialists are responsible for learning and understanding the entire front-end process to ensure successful service for our patients.
The Customer Service Specialists works in a fast-paced environment answering inbound calls and making outbound calls.
Maybe responsible for obtaining, analyze, and verify the accuracy of information received from referrals, create orders, and or schedule the patient to receive equipment as ordered by their doctor.
Customer Service Specialists should educate Patients of their financial responsibility when applicable.
*Essential Functions and Job Responsibilities: * * Develop and maintain working knowledge of current products and services offered by the company * Answer all calls and emails in a timely manner, in adherence to their goals * Document all call information according to standard operating procedures * Answer questions about products and services, retail stores, general service line information and other information as necessary based on customer call needs * Process orders, route calls to appropriate resource, and follow up on customer calls where necessary * Review all required documentation to ensure accuracy * Accurately process, verify, and/or submit documentation and orders * Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles * Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required * Must be able to navigate through multiple online EMR systems to obtain applicable documentation * Enter and review all pertinent information in EMR system including authorizations and expiration dates * Communicate with Customer Service and Management on an on-going basis regarding any noticed trends with insurance companies * Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered * Responsible for contacting patient when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.
* Meet quality assurance requirements and other key performance metrics * Facilitate resolution on customer complaints and problem solving * Pays attention to detail and has great organizational skills * Actively listens to patients and handle stressful situations with compassion and empathy * Flexible with the actual work and the hours of operation * Utilize company provided tools to maintain quality.
Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (the Medicare Provider Enrollment, Chain, and Ownership System) and “How-To” documents * Develop and maintain working knowledge of current HME products and services offered by the company.
* Maintain patient confidentiality and function within the guidelines of HIPAA.
* Completes assigned compliance training and other educational programs as required.
* Maintains compliant with AdaptHealth’s Compliance Program.
* Assist operations with on-call responsibilities as needed during non-business hours in accordance with company policy.
* Depending on the geographic territory and size of the branch location, may require assisting operations with deliveries.
* Retain knowledge of and consistently adhere to procedures for the use of Personal Protective Equipment (PPE), infection control and hazardous materials handling.
*Job Description * * Perform other related duties as assigned.
*Competency, Skills and Abilities: * * Excellent customer service skills * Analytical and problem-solving skills with attention to detail * Decision Making * Excellent ability to communicate both verbally and in writing * Ability to prioritize and manage multiple tasks * Proficient computer skills and knowledge of Microsoft Office * General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.
* Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
* Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
* Ability to work independently as well as follow detailed directives * Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction Computer skills including knowledge of Microsoft Office applications *Education and Experience Requirements: * * High School Diploma or equivalent * One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
* Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.
* Exact job experience is considered any of the above tasks in a Medicare certified.
*Physical Demands and Work Environment: * * Work environment may be stressful at times, as overall office activities and work levels fluctuate * Must be able to bend, stoop, stretch, stand, and sit for extended periods of time * Subject to long periods of sitting and exposure to computer screen * Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use * Must be able to lift 5 to 10 pounds periodically as needed.
* Excellent ability to effectively communicate both verbally and written with customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy.
* Mental alertness to perform the essential functions of position.
* May be exposed to angry or irate customers or patients * May be exposed to hazardous materials, loud noise, extreme heat/cold, direct, or indirect contact with airborne, bloodborne, and/or other potentially infectious pathogen.
*Employee Acknowledgement * This job description is intended as a summary of the primary responsibilities of and qualifications for this position.
It is not intended as inclusive of all duties an individual in this position might be asked to perform or of all qualifications that may be required for this position either now or in the future.
AdaptHealth reserves the right to amend this job description at any time with notice to the employee.
By signing this job description, I acknowledge that I have reviewed the document and understand the expectations of the position.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Employee Signature Print Name Date Job Type: Full-time Benefits: * 401(k) * 401(k) matching * Dental insurance * Health insurance * Paid time off * Vision insurance Shift: * 8 hour shift * Day shift Weekly day range: * Monday to Friday Work setting: * In-person Work Location: In person
The Customer Service Specialists works in a fast-paced environment answering inbound calls and making outbound calls.
Maybe responsible for obtaining, analyze, and verify the accuracy of information received from referrals, create orders, and or schedule the patient to receive equipment as ordered by their doctor.
Customer Service Specialists should educate Patients of their financial responsibility when applicable.
*Essential Functions and Job Responsibilities: * * Develop and maintain working knowledge of current products and services offered by the company * Answer all calls and emails in a timely manner, in adherence to their goals * Document all call information according to standard operating procedures * Answer questions about products and services, retail stores, general service line information and other information as necessary based on customer call needs * Process orders, route calls to appropriate resource, and follow up on customer calls where necessary * Review all required documentation to ensure accuracy * Accurately process, verify, and/or submit documentation and orders * Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles * Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required * Must be able to navigate through multiple online EMR systems to obtain applicable documentation * Enter and review all pertinent information in EMR system including authorizations and expiration dates * Communicate with Customer Service and Management on an on-going basis regarding any noticed trends with insurance companies * Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered * Responsible for contacting patient when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.
* Meet quality assurance requirements and other key performance metrics * Facilitate resolution on customer complaints and problem solving * Pays attention to detail and has great organizational skills * Actively listens to patients and handle stressful situations with compassion and empathy * Flexible with the actual work and the hours of operation * Utilize company provided tools to maintain quality.
Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (the Medicare Provider Enrollment, Chain, and Ownership System) and “How-To” documents * Develop and maintain working knowledge of current HME products and services offered by the company.
* Maintain patient confidentiality and function within the guidelines of HIPAA.
* Completes assigned compliance training and other educational programs as required.
* Maintains compliant with AdaptHealth’s Compliance Program.
* Assist operations with on-call responsibilities as needed during non-business hours in accordance with company policy.
* Depending on the geographic territory and size of the branch location, may require assisting operations with deliveries.
* Retain knowledge of and consistently adhere to procedures for the use of Personal Protective Equipment (PPE), infection control and hazardous materials handling.
*Job Description * * Perform other related duties as assigned.
*Competency, Skills and Abilities: * * Excellent customer service skills * Analytical and problem-solving skills with attention to detail * Decision Making * Excellent ability to communicate both verbally and in writing * Ability to prioritize and manage multiple tasks * Proficient computer skills and knowledge of Microsoft Office * General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.
* Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.
* Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
* Ability to work independently as well as follow detailed directives * Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction Computer skills including knowledge of Microsoft Office applications *Education and Experience Requirements: * * High School Diploma or equivalent * One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
* Senior level requires two (2) years of work-related experience and one (1) year of exact job experience.
* Exact job experience is considered any of the above tasks in a Medicare certified.
*Physical Demands and Work Environment: * * Work environment may be stressful at times, as overall office activities and work levels fluctuate * Must be able to bend, stoop, stretch, stand, and sit for extended periods of time * Subject to long periods of sitting and exposure to computer screen * Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use * Must be able to lift 5 to 10 pounds periodically as needed.
* Excellent ability to effectively communicate both verbally and written with customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy.
* Mental alertness to perform the essential functions of position.
* May be exposed to angry or irate customers or patients * May be exposed to hazardous materials, loud noise, extreme heat/cold, direct, or indirect contact with airborne, bloodborne, and/or other potentially infectious pathogen.
*Employee Acknowledgement * This job description is intended as a summary of the primary responsibilities of and qualifications for this position.
It is not intended as inclusive of all duties an individual in this position might be asked to perform or of all qualifications that may be required for this position either now or in the future.
AdaptHealth reserves the right to amend this job description at any time with notice to the employee.
By signing this job description, I acknowledge that I have reviewed the document and understand the expectations of the position.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Employee Signature Print Name Date Job Type: Full-time Benefits: * 401(k) * 401(k) matching * Dental insurance * Health insurance * Paid time off * Vision insurance Shift: * 8 hour shift * Day shift Weekly day range: * Monday to Friday Work setting: * In-person Work Location: In person
• Phone : NA
• Location : 3209 Gresham Lake Road, Raleigh, NC
• Post ID: 9087959983
