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The Customer Service Representative answers all incoming calls from sponsors, members, and providers, researches claim status, and assists in bringing resolution to claim problems. This position is also responsible for maintaining positive relationships with physicians, providers, and practice managers within the provider network. Provides high quality service daily to all callers. Assists with special projects as assigned.
Answer incoming calls from members and providers and establishing/maintaining good rapport while balancing 2-3 phone queues
Provide accurate information regarding eligibility, benefit verification, network and contract status to callers
Provide information to callers concerning claims questions, research as necessary to assist in resolving issues related to claims reimbursement
Document accurate information concerning calls into computer system
Maintain member files, assist with educating, orientation and credentialing providers
Maintain current member demographic information, processing address changes in a timely manner
Keep the commitment to follow up with members and providers within contractually agreed upon time frame
Consistently collaborating with all other departments , serving as a provider liaison with focus on provider retention
Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
Requirements:
High school diploma or GED equivalency
Minimum of 6 months experience in healthcare or medical related field
Good typing skills
Operating knowledge of computers using multiple programs simultaneously
Good telephonic skills in order to present information in an accurate and positive manner
Excellent written and oral communication skills
Ability to work independently and as a positive team player; requires daily direct supervision
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.
