Summary:

The Member Services Representative answers all incoming calls from sponsors, members, and providers, researches claim status, and assists in bringing resolution to claim problems. This position is also responsible for maintaining positive relationships with physicians, providers, and practice managers within the provider network. Provides high quality service daily to all callers.

• Answer incoming calls from members and providers and establishing/maintaining good rapport while balancing 2-3 phone queues
• Provide accurate information regarding eligibility, benefit verification, network and contract status to callers
• Provide information to callers concerning claims questions, research as necessary to assist in resolving issues related to claims reimbursement
• Document accurate information concerning calls into computer system
• Maintain member files, assist with educating, orientation and credentialing providers
• Maintain current member demographic information, processing address changes in a timely manner
• Keep the commitment to follow up with members and providers within contractually agreed upon time frame
• Consistently collaborating with all other departments , serving as a provider liaison with focus on provider retention
• Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

Requirements:

• High school diploma or GED equivalency
• Minimum of 6 months experience in healthcare or medical related field
• Good typing skills
• Operating knowledge of computers using multiple programs simultaneously
• Good telephonic skills in order to present information in an accurate and positive manner
• Excellent written and oral communication skills
• Ability to work independently and as a positive team player

Work Type: 

Full Time