Offer summary

Qualifications:

High school diploma or equivalent required., Minimum of two years of customer service experience in a call center environment, preferably in healthcare., Ability to multi-task and prioritize in a fast-paced environment., Proficiency in Microsoft Office, especially Excel and Word, is necessary. .

Key responsabilities:

Answer telephone calls promptly and professionally, acting as a liaison between various stakeholders.

Assist customers with inquiries related to claims, eligibility, referrals, and billing.

Document every call thoroughly and ensure compliance with HIPAA requirements.

Communicate recurring issues and trends to management and follow up on open issues.

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. In the months and years ahead, we will be offering our services in other states and other markets throughout the nation. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. Our pledge to members is that we will give you exceptional care delivered by compassionate physicians who have a strong commitment to each and every patient. Our physicians work closely with teams of skilled nurses and other healthcare professionals. Prospect Medical contracts with most major health plans, and we serve all product lines, including Commercial, Medicare, Medicaid, Medicare/Medicaid (Medi-Medi) and Health Insurance Exchange. To further improve the health of the communities we serve, Prospect Medical offers comprehensive health education classes and support services through our numerous outreach programs. Diversity and Inclusion Within Our Workforce At Prospect Medical, we believe that a diverse and inclusive environment enriches our workforce and the communities we serve. To that end, we embrace the diversity of our coworkers, physicians, vendors and patients. We do not tolerate harassment or discrimination on the basis of race, ethnicity, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, veteran status or any other characteristics protected by law. We embrace diversity because it is our culture, and it is the right thing to do.

Job description

Job Description

This position is responsible for answering telephone calls in a prompt, courteous, professional manner and acting as a liaison between Prospect Medical/ProMed Healthcare and: members; contracted and non-contracted care providers, ancillary providers; health plans; billing companies; collection companies, to provide assistance and respond to service requests. Representative is responsible for being a resource for other team members.

Responsibilities

Assist customers on the telephone with inquiries, updates, changes related but not limited to claims, eligibility, referrals, PCP changes, billing, access, transportation and general coordination of care through thorough research in a timely manner. The monthly expectation is to perform at a quality level of 90% accuracy of all measures. The daily expectation is to efficiently answer a minimum of 60 calls per day (inbound).
100% thorough documentation of every call.
Thoroughly verify HIPAA requirements to ensure account accuracy.
Follow-up on all open issues.
Communicate recurring issues and trends to management.
All other duties assigned.

Qualifications

Minimum Education: High school diploma or equivalent.

Minimum Experience: A minimum of two (2) years of customer service experience in a call center environment required. Within a health care setting preferred. Ability to multi-task, prioritize, and work in a fast pace environment. Ability to multi-task, prioritize, and work in a fast pace environment. Knowledge of HIPAA regulations preferred. Knowledge of IPA operations in a health care setting preferred. Knowledge and experience of claims , eligibility, and referrals preferred. Must be proficient in Microsoft Office navigation, Excel, and Word and/or IDX knowledge.

Req. Certification/Licensure: None

"Location-Based Pay Adjustment"

Required profile