Member Service Rep 1

Mercy Health System Janesville , WI 53548

Posted 2 months ago

JOB SUMMARY##### Responds to all incoming correspondence and telephone inquiries directly related to the CSR 1 position in a professional manner consistent with the mission of the health system. Attend seminars/training sessions.

May be required to work overtime during peak periods. Performs other duties as assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES# ##Responds to all incoming telephone calls.# ##Resolves all inquiries in a professional manner consistent with the mission of the health system.# ##Assist callers with complaints, appeals, grievances and IRO requests.# ##Attend seminars/training sessions.# ##Specific responsibilities include all Level 1 Member Service requirements as well as the following:# update all SOP#s directly related to any responsibilities of a CSR 1; adding membership to the PBM software; adding authorizations to the PBM software; processing all prescription claims (DMR) through the PBM software;# Respond to 100% of overflow phone calls by the time standards for A.M. and P.M. messages;# Send out delays letters for all complaints within time standards established; CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS To perform the job successfully, an individual should demonstrate the following behavior expectations: Quality

  • Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals. Service

  • Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions. Partnering

  • Shows commitment to the# Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other#s views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals. Cost

  • Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue. EDUCATION # EXPERIENCE# Associate#s degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.

ADDITIONAL REQUIREMENTS Passing the Driver


#s License Check and/or Credit Check (for those positions requiring). Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check. Must be able to follow written/oral instructions.

Language Skills Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Mathematical Skills Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry. Reasoning Ability Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.

Ability to deal with problems involving a few concrete variables in standardized situations. Computer Skills To perform this job successfully, an individual should have knowledge of previous claims processing systems; Spreadsheet software and Word Processing software. WORK ENVIRONMENT The noise level in the work environment is usually moderate.

Occupational Exposure: Category C - No partners in the specified job classification have occupational exposure. AGE OF PATIENTS SERVED Adult (18 years # 64 years) Geriatric (65 years and older) INFORMATION ACCESS Partner may access patient care information needed to perform their job duties.

WORK CONTACT GROUP### Members, employers, insurance companies, internal partners, hospital and clinic personnel.# ### SPECIAL PHYSICAL DEMANDS The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations. While performing the duties of this Job, the employee is regularly required to sit, talk and hear. The employee is frequently required to use hands to finger, handle, or feel and reach with hands and arms.

Specific vision abilities required by this job include close vision, peripheral vision and ability to adjust focus. The employee is occasionally exerting up to 20 pounds of force. Must use a computer, keyboard, mouse and specific computer programs as required.



LEVEL OF SUPV/SUPERVISES################### ### This job has no supervisory responsibilities.


JOB SUMMARY

Responds to all incoming correspondence and telephone inquiries directly related to the CSR 1 position in a professional manner consistent with the mission of the health system. Attend seminars/training sessions.

May be required to work overtime during peak periods. Performs other duties as assigned.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Responds to all incoming telephone calls.

  • Resolves all inquiries in a professional manner consistent with the mission of the health system.

  • Assist callers with complaints, appeals, grievances and IRO requests.

  • Attend seminars/training sessions.

  • Specific responsibilities include all Level 1 Member Service requirements as well as the following: update all SOP's directly related to any responsibilities of a CSR 1; adding membership to the PBM software; adding authorizations to the PBM software; processing all prescription claims (DMR) through the PBM software; Respond to 100% of overflow phone calls by the time standards for A.M. and P.M. messages; Send out delays letters for all complaints within time standards established;

CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONS

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality

  • Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service

  • Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.

Partnering

  • Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost

  • Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.

EDUCATION & EXPERIENCE

Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.

ADDITIONAL REQUIREMENTS

Passing the Driver's License Check and/or Credit Check (for those positions requiring).

Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check.

Must be able to follow written/oral instructions.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Mathematical Skills

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.

Reasoning Ability

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.

Ability to deal with problems involving a few concrete variables in standardized situations.

Computer Skills

To perform this job successfully, an individual should have knowledge of previous claims processing systems; Spreadsheet software and Word Processing software.

WORK ENVIRONMENT

The noise level in the work environment is usually moderate.

Occupational Exposure: Category C - No partners in the specified job classification have occupational exposure.

AGE OF PATIENTS SERVED

Adult (18 years

  • 64 years)

Geriatric (65 years and older)

INFORMATION ACCESS

Partner may access patient care information needed to perform their job duties.

WORK CONTACT GROUP

Members, employers, insurance companies, internal partners, hospital and clinic personnel.

SPECIAL PHYSICAL DEMANDS

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.

While performing the duties of this Job, the employee is regularly required to sit, talk and hear. The employee is frequently required to use hands to finger, handle, or feel and reach with hands and arms.

Specific vision abilities required by this job include close vision, peripheral vision and ability to adjust focus. The employee is occasionally exerting up to 20 pounds of force. Must use a computer, keyboard, mouse and specific computer programs as required.

LEVEL OF SUPV/SUPERVISES

This job has no supervisory responsibilities.



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Member Service Rep 1

Mercy Health System