Responds to basic and routine inquiries through phone or e-mail contact with customers and prospects about the Company’s products/services following standard scripts and procedures. Uses a computer system to track information, questions, answers, and product orders. Promotes and maintains positive customer relations.
ESSENTIAL JOB FUNCTIONS
Contacts all appropriate parties to obtain, verify, and validate correct claim information.
Contacts insurance carriers, employers, doctors, patients, and regulatory agencies to explain StoneRiver Pharmacy’s role in the workers’ compensation process.
Exhibits a clear understanding of verification processes, such as Pending Scrub and daily import, as well as other assigned tasks.
Verifies critical information, per Company policy, to minimize financial risk and processing of prescriptions.
Documents accurate and complete notes of all account interactions.
Communicates with Supervisors on repeating or prevalent carrier/claim issues, and strives to resolve those issues.
Responds to incoming calls from carriers, pharmacies, attorneys, employers, patients and regulatory agencies.
Maintains patient privacy and confidentiality under requirements of federal and state law, including HIPAA, and in accordance with Progressive Medical and/or StoneRiver Pharmacy Solutions policy.
ADDITIONAL DUTIES AND RESPONSIBILITIES
Assumes additional responsibilities and performs special projects as needed or directed.
REQUIRED QUALIFICATIONS
Education, Training and/or Experience
High school diploma or equivalent and previous customer service experience.
Knowledge, Skills, Abilities and Personal Characteristics
Customer service skills; phone etiquette.
Ability to meet established departmental production and quality standards.
Effective written, verbal, and interpersonal communication skills; must be able to read, write, and interpret documents and speak fluent English.
Ability to perform duties independently.
Strong attention to detail; ability to multi-task and organize work.
Ability to succeed in a fast-paced, high stress, and rapidly changing environment.
Basic math/analytical skills.
Proficient with computers; Microsoft Office experience.
PREFERRED QUALIFICATIONS
Previous call center experience.
Workers’ compensation (WC) and/or healthcare experience; familiarity with WC laws, rules, and regulations for assigned state(s).
Basic understanding of insurance processes and/or medical billing.
PHYSICAL DEMANDS
Nature of work requires an ability to operate standard business office equipment. Requires ability to communicate and exchange information, collect, compile and prepare work documents, set-up and maintain work files.
WORKING CONDITIONS
Work performed in a general office environment. Requires sitting for long periods of time, standing, and walking; may occasionally lift and move up to 25 pounds. Must be able to work in a busy, high-stress environment. May require flexibility to adjust work schedule during peak periods.
The above statements are intended only to describe the general nature of the job, and should not be construed as an all-inclusive list of position responsibilities. Individuals may perform other duties as assigned, including work in other functional areas to cover absence or relief, or to equalize peak workload periods.
Employees must perform all of the essential functions/responsibilities with or without reasonable accommodation for classification in this position.
Helios is committed to equal employment opportunity in accordance with all applicable laws. Helios provides reasonable accommodation for qualified individuals with disabilities in the job application process. Helios is an Equal Employment Opportunity/Affirmative Action Employer and maintains a Drug-Free Workplace.
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