Responsible for the coordination and collaboration of provider phone calls related to pre-treatment review status
Perform all customer service-related duties of the ACM team related to service/authorization requests
Answers telephone calls pertaining to pre-treatment review status
Answers telephone calls pertaining to Case Management services and directs appropriately
Provides clear and accurate responses to requests for information
Documents all calls in Case Management platform for future referral
Returns messages left in designated voice mailboxes
Reads and interpreters plan documentation language pertaining to review requirements
Meets or exceeds company standards for production and quality
Contributes to the daily workflow with regular and punctual attendance
Follows up with callers when research is needed to provide accurate answers
Communicate with providers when and what specific additional information is needed to complete a review
Distribute medical review response letters via fax as requested
Initiates referrals for Case Management when appropriate
When necessary, verifies request CPT/ICD codes, and utilizes the CPT database to determine if review is recommended
Promotes the use of ACMs external self-service tools to eliminate unnecessary calls
Assists in managing incoming fax queue as necessary

High school graduation or GED required
Basic computer and customer service required
Medical terminology and medical coding experience preferred
Excellent oral and written communication skills required
PC skills, including Windows and Word
Good interpersonal skills, works effectively with others
Ability to organize and recall large amounts of detailed information
Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations
Ability to identify errors/oversights and make corrections
Ability to project a professional image and positive attitude in any work environment
Ability to comply with privacy and confidentiality standards
Ability to be flexible, work under pressure, meet deadlines
Ability to analyze and solve problems with professionalism and patience

Customer Service Representative

Key skills