Customer Service Representative

Customer Service Specialist I

We are seeking a Customer Service Specialist I to join our Unified Contact Center team. This role is responsible for providing outstanding customer service while handling inbound and outbound calls, including but not limited to authorizations, referrals, access to care, claims, eligibility, and benefits. The representative will serve as the first point of contact for patients, members, health plans, and providers, ensuring accurate information, timely resolution, and compassionate support.

You will focus on:

• Handling Inquiries: Responding to customer inquiries and complaints via phone, email, or other communication channels.
• Problem Resolution: Clarifying customer issues, determining the cause, selecting the best solutions, and following up to ensure resolution
• Professionalism: Maintaining a high level of professionalism and establishing a positive rapport with customers
• Updating Records: Updating member information in Epic during and after each interaction.
• Healthcare Knowledge: Staying informed about IPA services, healthcare policies, and procedures.
• Escalation: Identifying and escalating complex issues to supervisors or relevant Departments.
• Training Participation: Participating in training sessions to improve knowledge of healthcare services and customer service skills.
• Member/Provider Engagement: Building sustainable relationships and trust with the callers through open and interactive communication.
• Access to Care: Assisting with providing locations of services for members, such as ancillary providers, and providing information on healthcare plans.
• Compliance: Ensuring compliance with healthcare regulations and IPA policies

The Skills, Experience & Education:

• Knowledge of medical and health insurance terminology.
• Knowledge of Medicare, Medicaid, and commercial insurance.
• Ability to multitask in a fast-paced call center environment.
• Strong customer service skills with the ability to handle sensitive and complex inquiries.
• Clear communication skills to explain insurance and medical processes in simple terms.
• 2 years of experience with medical billing and coding (CPT, ICD-10) and insurance processes.
• 2 years of prior experience in a medical call center or healthcare customer service role highly desirable.

Technical Skills:

• Proficiency with Epic electronic medical records system for patient data and scheduling.
• Experience using RingCentral for call management, routing, and communication.
• Strong technical proficiency with CRM systems, EMR platforms, and insurance portals.
• Familiarity with Athenahealth (Athena) billing system for claims and billing functions.

Preferred Qualifications:

• Bilingual skills (Spanish/English or other languages) to better serve diverse patient populations.
• Prior experience with medical billing, coding, claims processing, authorizations, eligibility, benefits, and referrals in a healthcare setting.
• Understanding call center performance metrics (average handle time, first call resolution, call quality).

Education:

High School Diploma or GED