Customer Service Rep III - PHC

Peer Mentor

This employee is a peer mentor for the department, responsible for setting a professional example in business acumen. This employee must accurately, thoroughly, and in a time-sensitive manner process patient orders and provide clear and timely communication to all stakeholders.

• Proficient in and performs all Customer Service I and II core responsibilities
• Respond to telephone inquiries and orders from patients and referral sources
• May assist walk-in patients with the selection of equipment, supplies, and services
• Determine resolution of patient and referral inquiries, questions, or concerns
  • Identify concerns and ensure they are recorded in Concern Tracker system when appropriate
• Complete electronic intake process in billing system, perform verification of insurance, and review all documentation for accuracy to qualify patient for services
• Contact patients to inform them of any patient payment requirements, collect payment, and determine best delivery method to provide instructions for receiving delivery
• Understand and abide by Accreditation Commission for Health Care (ACHC) requirements
• May need to understand and interpret Medicare guidelines and qualifying documentation
• Thoroughly understand payer and utilization guidelines
• May process insurance authorization and follow up on requests as needed
• Establish positive relationships with referral sources and build rapport with internal and external customers
• May be required to perform quality assurance process, confirming accuracy of orders prior to submission for reimbursement
• Understand C-PAP compliance guidelines as required by assignment or has obtained knowledge of rehab specialty equipment and coverage criteria
• Consistently meet Quality Assurance score of 85% or above
• Provide coverage in all areas of assigned department as needed
• Set the working example for other Patient Service employees in business acumen and knowledge
• Complete departmental projects as assigned
• Peer to peer coaching as needed

Education/Experience:

• High School diploma or GED equivalency required
• Prefer 2 years of home health, customer service, call center, or insurance experience
• Strong organization, communication, analytical, and problem-solving skills required
• Must have basic understanding of Microsoft Word, Excel, and excellent typing skills

Physical Demands:

The employee must occasionally lift and/or move up to 10 pounds.