Posted in Other 8 days ago.
Type: Full Time
Customer Service Representative II
Carbondale, IL REMOTE
Hours: Monday - Friday 8:30 am - 5:00 pm
Workers will be required to pick up PC on site in Carbondale, IL for set up and then will be deployed to work remotely. Workers should be prepared to return to the office once restrictions are lifted.
Customer Service Representative is the face of Healthcare and impacts
members' service experience by manner of how customer service inquiries
and problems via telephone, internet or written correspondence are
handled. Customer inquiries are of basic and at times complex nature.
Engages, consults and educates members based upon the member's
unique needs, preferences and understanding of Healthcare plans, tools and
resources to help guide the members along a clear path to care
The Healthcare Customer Service Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of Healthcare as the client and in accordance with Medicare Part D CMS Regulations. Must apply information [provided through multiple channels] to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
2 years experience in customer service, call center experience preferred.
Basic experience in MSWord and MSExcel.
Familiar with medical terminology and knowledge of medical coding.
Ability to read and interpret billing documents.
The position also requires an extensive amount of data entry work.
1.Strong Attention to detail 2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality 3.Proficient computer skills and the ability to navigate in a Windows based environment 4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible 5.Ability to work in a high pressure, time sensitive environment 6.Project a professional business image, through phone interaction as well as internal communications 7.Demonstrated problem-solving ability and attention to detail 8.Demonstrated sense of urgency with assignments 9.Strong organizational skills 10.Strong telephone skills 11.Ability to read and understand pharmacy/medical terminology 12.Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations. 13.Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required 14.Ability to interpret a variety of work instructions provided through a variety of mediums 15.Ability to anticipate needs and resolve issues with urgency 16.Ability to consistently meet quality and production standards 17.Displays confidence in the ability to learn complex material 18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results
High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.
NTT DATA, Inc. (the Company ) is an equal opportunity employer and makes employment decisions on the basis of merit and business needs. The Company will consider all qualified applicants for employment without regard to race, color, religious creed, citizenship, national origin, ancestry, age, sex, sexual orientation, genetic information, physical or mental disability, veteran or marital status, or any other class protected by law. To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship to the Company would result.