Customer Service Representative

Job Description

Job Description

Company: Family Choice Management Services (FCMS)

About Us: Family Choice MSO's mission is to provide comprehensive, efficient, and high-quality management and administrative support to medical practices. By handling the non-clinical aspects of medical operations, the MSO enables healthcare providers to focus on delivering exceptional patient care. The MSO is dedicated to fostering the growth and sustainability of medical practices by offering expert services in administration, finance, human resources, compliance, and technology.

Reports to: Customer Service/Provider Relation Manager

Job Summary:

The Customer Relations Specialist is responsible for providing exceptional support and service to patients, medical providers, and other stakeholders within the Independent Practice Association (IPA). The CRS will assist Medicaid and Medicare patients with their inquiries, help them navigate their healthcare benefits, and resolve any issues related to their care. This role is crucial in ensuring that patients receive the care they need and that providers are supported in delivering high-quality services.

Key Responsibilities:

Patient Assistance and Support:

Respond to inbound calls, emails, and other communications from Commercial, Medi-Cal, and Medicare patients, addressing their inquiries regarding healthcare services, benefits, and claims.

Assist patients in understanding their insurance coverage, benefits, and eligibility, specifically related to Commercial, Medi-Cal and Medicare programs.

Provide guidance on how to access services within the IPA network, including scheduling appointments, referrals, and care coordination.

Issue Resolution:

Handle patient complaints and concerns with empathy and professionalism, working to resolve issues related to billing, claims, and service access promptly.

Collaborate with internal departments, such as billing, provider relations, and care management, to address and resolve patient issues.

Escalate complex issues to the Customer Service Manager or appropriate department when necessary.

Provider Support:

Assist medical providers within the IPA with inquiries related to patient eligibility, benefits verification, and claims processing.

Provide timely and accurate information to providers to help them navigate Medicaid and Medicare regulations and requirements.

Documentation and Reporting:

Accurately document all patient interactions, issues, and resolutions in the customer service database or electronic health records (EHR) system.

Generate reports on common patient inquiries, complaints, and service trends to help identify areas for improvement.

Education and Outreach:

Educate patients on preventive care services, wellness programs, and other resources available through Commercial, Medicaid, and Medicare health plans

Participate in outreach efforts to ensure patients are informed about changes in benefits, healthcare options, and the services provided by the IPA.

Compliance and Confidentiality:

Ensure all interactions comply with federal and state regulations, including HIPAA, CMS guidelines, and Medicaid and Medicare requirements.

Maintain patient confidentiality at all times, adhering to the organization’s privacy policies and procedures.

Continuous Improvement:

Provide feedback to the Customer Service Manager on ways to improve patient service and satisfaction.

Participate in ongoing training and development to stay current with changes in Medicaid and Medicare programs, as well as best practices in customer service.

Qualifications and Requirements:

Education:

High school diploma or equivalent required.

Associate’s degree or higher in a related field (e.g., healthcare administration or business) is preferred.

Experience:

Minimum of 2 years of experience in a customer service role, preferably in a healthcare setting.

Experience working with Medicaid and Medicare patients is highly desirable.

Familiarity with healthcare insurance, claims processing, and benefits coordination.

Skills:

Bilingual Required: English and Spanish 

Communication: Strong verbal and written communication skills, with the ability to explain complex information clearly and concisely to patients and providers.

Empathy and Patience: Ability to handle sensitive situations with empathy and patience, particularly when dealing with vulnerable populations such as Medicaid and Medicare patients.

Problem-solving: Effective problem-solving skills, with the ability to think critically and resolve issues efficiently.

Technical Proficiency: Comfortable using customer service software, EHR systems, and Microsoft Office Suite (Word, Excel, Outlook).

Attention to Detail: Strong attention to detail, ensuring accuracy in all documentation and communications.

Multitasking: Ability to manage multiple tasks simultaneously while maintaining a high level of service.

Personal Attributes:

Compassionate: A genuine desire to help others and improve patient experiences.

Team-Oriented: Works well in a team environment, collaborating with colleagues to achieve common goals.

Reliable: Dependable and punctual, with a strong work ethic.

Adaptable: Able to adjust to changes in processes, regulations, and patient needs

Work Location: In person