Customer Service Specialist

Customer Service Specialist Location: Chicago, IL 60643 Work Type: Full-Time, On-Site Make a Meaningful Impact Every Day Are you passionate about helping others and looking for a career with purpose? At ActivStyle, we're dedicated to improving lives by providing essential home-delivered medical supplies that help individuals maintain their dignity, independence, and quality of life. We're currently seeking a Customer Service Specialist to join our team in Chicago, IL. In this role, you'll serve as a trusted resource for our clients, helping them obtain vital products such as incontinence supplies, urological products, and other personal care essentials delivered directly and discreetly to their homes. If you enjoy building connections, solving problems, and making a difference in the lives of others, we'd love to hear from you. Position Summary Customer Service Specialists are responsible for learning and understanding the entire front-end and resupply process to ensure successful service for our patients. You'll work in a fast-paced environment answering inbound calls and making outbound calls. You may be responsible for obtaining, analyzing, and verifying the accuracy of information received from referrals, creating orders, and scheduling patients to receive supplies or equipment as ordered by their doctor. Customer Service Specialists educate patients about their financial responsibility when applicable. Essential Functions and Responsibilities Develop and maintain working knowledge of current products and services offered by the company Answer all calls and emails in a timely manner, in adherence to performance goals Document all call information according to standard operating procedures Answer questions about products, services, retail stores, and general service line information based on customer needs Process orders, route calls to appropriate resources, and follow up on customer calls where necessary Review all required documentation to ensure accuracy Accurately process, verify, and submit documentation and orders Complete insurance verification to determine patient eligibility, coverage, co-insurances, and deductibles Obtain pre-authorization if required by an insurance carrier and process physician orders for approval Navigate multiple online EMR systems to obtain applicable documentation Enter and review all pertinent information in EMR system including authorizations and expiration dates Communicate with Customer Service and Management regarding noticed trends with insurance companies Verify insurance carriers are listed in the company's database system and request new carriers be entered when needed Contact patients when documentation doesn't meet payer guidelines to provide updates and offer additional options Meet quality assurance requirements and other key performance metrics Facilitate resolution on customer complaints and problem-solving Pay attention to detail with great organizational skills Actively listen to patients and handle stressful situations with compassion and empathy Be flexible with work schedules and hours of operation Utilize company-provided tools to maintain quality, including Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI, and PECOS Maintain patient confidentiality and function within HIPAA guidelines Complete assigned compliance training and other educational programs as required Maintain compliance with ActivStyle's Compliance Program Retain knowledge of and consistently adhere to procedures for Personal Protective Equipment (PPE), infection control, and hazardous materials handling Perform other related duties as assigned Required Qualifications High School Diploma or equivalent One (1) year of work-related experience in healthcare administrative, financial, or insurance customer services, claims, billing, call center, or management Experience in a Medicare-certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance is preferred Excellent customer service skills Analytical and problem-solving skills with attention to detail Strong decision-making abilities Excellent verbal and written communication skills Ability to prioritize and manage multiple tasks simultaneously Proficient computer skills and knowledge of Microsoft Office Ability to adapt and be flexible in a rapidly changing environment Ability to work independently as well as follow detailed directives Mental alertness to perform essential functions of the position Nice-to-Have Skills General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements Experience with EMR systems Solid ability to learn new technologies and technical aptitude Experience in a healthcare or insurance environment Key Competencies Customer Service Excellence Problem-Solving and Analytical Thinking Communication (Verbal and Written) Multitasking and Time Management Technical Proficiency Adaptability and Flexibility Patience and Empathy Attention to Detail Accountability and Initiative Teamwork and Collaboration Physical Demands and Work Environment Work environment may be stressful at times as office activities and work levels fluctuate Ability to sit for extended periods of time with exposure to computer screens Ability to perform repetitive motions of wrists, hands, and fingers due to extensive computer use Ability to bend, stoop, and stretch as needed Ability to lift 5 to 10 pounds periodically as needed Excellent ability to effectively communicate both verbally and in writing with customers with empathy, compassion, courtesy, and respect for privacy May be exposed to angry or irate customers or patients May be exposed to hazardous materials, loud noise, extreme heat/cold, or direct/indirect contact with airborne, bloodborne, and other potentially infectious pathogens Compliance and Site Auditing Responsibilities Ensure ongoing compliance with ACHC and CMS regulatory standards, including participation in preparation, facilitation, and follow-up for accreditation and certification surveys Assist in internal and external audits, including document preparation, policy/procedure review, and evidence of compliance gathering Monitor and maintain documentation accuracy and readiness for review to demonstrate compliance with applicable ACHC, CMS, and other regulatory requirements Identify, report, and support corrective action planning related to audit findings or compliance gaps Collaborate with leadership to ensure continuous survey readiness, regulatory adherence, and quality improvement efforts Conditions of Employment Successful completion of a federal background check and other pre-employment checks Verification of employment eligibility Successful completion of an OIG (Office of Inspector General) exclusion check is required Candidates must not be excluded, debarred, or otherwise ineligible to participate in federally funded healthcare programs (e.g., Medicare, Medicaid) Amazing Benefits Team-Driven and Values-Based Culture Medical, Dental, and Vision Benefits Paid Time Off (PTO), Holiday Pay, Sick and Safe Time for Applicable States Employee Assistance Program Career Growth Opportunities 401(k) with Generous Employer Match Competitive Hourly Rate: $18.00/hour Our Commitment to You At ActivStyle, we don't just accept difference—we celebrate it, we support it, and we thrive on it for the benefit of our team and our community. We are proud to be an equal opportunity workplace and an affirmative action employer. This employer participates in E-Verify. Following acceptance of any job offer, at the start of employment, the employer will provide the federal government Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify is unable to verify your eligibility for employment, this employer will provide written instructions to give you an opportunity to contact the appropriate agencies and resolve the discrepancy prior to taking any action against continued employment. #J-18808-Ljbffr Page Mechanical Group, Inc.