Customer Service Representative III

Job Description

The Customer Service Representative III position is responsible to assist with walk-in members/providers and answer escalated telephone calls in a prompt, courteous, professional manner and acting as a liaison between Prospect Medical/ProMed Healthcare and: members; contracted and non-contracted care providers, ancillary providers; health plans; billing companies; collection companies, to provide assistance and respond to service requests. Representative is responsible for being a resource for department team members. **

Responsibilities**

• Assist customers and Customer Service representatives with escalated issues; in person (walk-ins) or on the telephone in a courteous, professional manner with inquiries, updates, changes related but not limited to claims, eligibility, referrals, PCP changes, billing, access, transportation and general coordination of care through thorough research in a timely manner.
• 100% thorough documentation of every call.
• Thoroughly verify HIPAA requirements to ensure account accuracy.
• Follow-up and respond to external department on all open issues.
• Actively support supervisors and supervisors’ needs as required.
• Identify and support/quality training opportunities for staff.
• Communicate recurring issues and trends to management.
• All other duties assigned.

Qualifications

Minimum Education: High School Diploma or equivalent required. Bachelor’s Degree preferred. **

Minimum Experience: A minimum of four (4)years of customer service experience in a call center environment required. Within a health care setting preferred. Knowledge and experience of claims , eligibility, and referrals preferred. Bilingual preferred. Knowledge of IPA operations in a health care setting required. Knowledge of HIPAA regulations required. Ability to make decisions in the absence of detailed instructions. Exceptional customer service and conflict resolution skills. Excellent written and verbal communication skills. Ability to multi-task, prioritize, and work in a fast pace environment.

Req. Certification/Licensure: None

About Us**

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.