Field Service Engineer 2
GE HealthCare
Customer Service Team Lead
CVS Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $19 - $32 per hour
Job Level
Senior
About the role
- Performs intake of calls from members or providers regarding services via telephone, fax, or EDI
- Contacts providers with authorization, denial, and appeals process information; handles difficult customer interactions
- Utilizes appropriate system to build, research, and enter member information
- Screens requests for appropriate referral to medical services staff
- Approves services that do not require a medical review in accordance with the benefit plan
- Performs non-medical research including eligibility verification, coordination of benefits, and benefits verification
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
- Promotes communication, both internally and externally to enhance effectiveness of medical management services
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality
- Gathers information needed for coordinators/case managers to determine continued authorization
- Enters referrals for non-complex services including DME, physical therapy, inpatient and outpatient care, and special circumstance requests as defined by Utilization Management
- Provides education and acts as a resource to primary care practices and specialty care providers
- Supports the administration of the precertification process in compliance with various laws and regulations, URAQ and NCQA standards
- Under the supervision of clinical staff, places outbound calls to providers to obtain clinical information for approval of medical authorizations
- Assesses training needs within the team; serves as training resource, mentor, and coach to others
- Acts independently and manages own activities with minimal supervision and direction; assists other team members; takes ownership for problem resolution
- Demonstrates, advocates, and reinforces a positive team environment
- Assists with the identification and reporting of potential quality management issues; responsible for assuring these issues are reported to the Quality Management Department
- Performs other related duties as required.
Requirements
- Minimum of 3 years experience as an Inbound/Outbound Queue Associate
- High School Diploma or G.E.D.
- Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook)
- Familiarity with basic medical terminology and concepts used in care management
- Strong customer service skills, effective communication, telephonic and organization skills
- Ability to handle difficult customer interactions
- Ability to effectively participate in a multi-disciplinary team
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality
- Ability to work a rotating schedule (projected Mon- Fri 8-5pm)
