fullTime

Customer Advocate

Paid40 hoursMontgomery CountyYear Round

Description

Compiles, proofs and processes information received from providers/adjusters to aid the Clinical Reviewers to perform clinical reviews. Performs review of service requests, collects non-clinical and structured clinical data, and performs scripted clinical screening that does not require evaluation or interpretation of clinical information. The CSR needs to exhibit the ability to contribute to the overall success of the HES Advocates Team by assisting in the management of continued authorization requests via fax. The CSR must be well organized and have the ability to perform multiple tasks including but not limited to: monitoring assigned caseload and answering and/or researching questions about cases

Responsibilities

• Provide excellent customer service skills to internal and external customers via phone, fax, and email
o Work within strict timelines in accordance with the continued authorization process
o Work closely with the Clinical Advocates to manage utilization
o Consistently manage incoming documentation via the Advocate fax line
• Compliance with HIPAA guidelines
• Build relationships through dependable communications between adjusters, NCMs, and our network providers
• Be familiar with client profiles and requirements
• Utilize available licensed health professionals to ensure quality performance of duties
• Maintain compliance with Company policies and procedures
• Meet Company Quality Improvement guidelines
• Complete special projects as assigned

Requirements

Requirements

• Proficiency in Computer usage
• Prior experience in health related field, knowledge or medical terminology and ICD-9/CPT coding is a plus
• 2-3 years customer service experience

Global Employment Solutions is an Equal Opportunity Employer