Customer Solutions Expert I - Verifications
Hartford , CT 06183
Posted 2 weeks ago
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Identify the need(s) of the referring source and/or patient by collecting all necessary data relevant to that need; interpret, verify and process that data to determine if patient is eligible; and facilitate the initiation and termination of the care and services provided in a timely manner. Respond to customer issues that may arise during and after order processing.
Actively engages and coordinates with other team members to maintain a positive, collaborative relationship. Works under close supervision.
- Works closely with health plans/payers and maintains strong business relationships. Provides appropriate issue resolution and/or escalation when needed.
Works under moderate supervision, with clinical oversight. Reviews and adheres to all Company policies and procedures and the Employee Handbook. Participates in special projects and performs other duties as assigned.
Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills. Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking. Participates in and contributes to performance improvement activities. Learn, understand and maintain working knowledge of products and services offered by the company.
- Receives and responds to incoming calls or faxes from providers, referral sources, and potential patients. Accurately enters information to begin the referral process into the CareCentrix portal and accurately records the outcome of calls in the proper screen.
Collects and enters clinical and demographic information to begin the referral process along with verifying eligibility and benefits information by contacting health plans or payors to ensure services provided will be covered by the carrier. (e.g., deductible amounts, co-payments, effective date, pre-existing clauses, levels of care, authorization, visit limitations, documentation required to process claims, etc.). Accurately documents all communications and decisions into a computer database. Consults applicable Payer Fact Sheets in Intake Process. Works with other staff and patients to identify potential solutions as problems are identified with payer sources.
Identifies potential payer sources, obtains authorization from the authorizing entity. Accurately documents conversations and decisions with payer sources Processes SV Alerts and communicates resolution to the quality team and the patient. Responsible for logging all interactions and thoroughly following up with members and providers. Files CARTs, completes the Internal Issue Log, and SOC templates when applicable.
- Requires a HS diploma or equivalent; up to 1 year of previous related experience; or any combination of education and experience, which would provide an equivalent background. One year billing, insurance or claims experience.
The ability to effectively multi-task. Medical terminology, insurance verification or healthcare experience preferred. Must be proficient and comfortable in a computer-based environment.
Embraces the values of accountability, consistency, engagement, patient compassion, empowerment, respect and outstanding service. This position requires excellent communication, customer service and problem solving skills, as well as the ability to effectively interact with all levels of management and highly diverse customers. Must have strong organizational skills and be extremely detail-oriented.
Demonstrates critical thinking and has the ability to analyze data to understand an expected outcome, Must be able to effectively manage and prioritize tasks and thrive in a fast-paced environment. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Masters the Intake/Verifications function as well as a second function; Staffing as back-up and learns two health plans.
CareCentrix maintains a drug-free workplace in accordance with Florida's Drug Free Workplace Law.