GENERAL SUMMARY
Responsible for providing telephonic support to members and those acting on members behalf by responding to routine inquiries concerning eligibility information and benefit clarification. Assists members and practitioners in the access of appropriate Employee Assistance Program services and routine ambulatory behavioral health care services. Work is performed within a team environment.
ESSENTIAL RESPONSIBILITIES
- Interfaces with members and providers via telephone to respond to routine inquiries.
- Researches and interprets member information by effectively using MHNet systems containing information including, but not limited to, member eligibility, member benefits, authorizations, and provider networks.
- Provides outpatient authorization to members and practitioners for routine ambulatory certifications not requiring case review.
- Refers members who require urgent or emergent care, or services rendered in a setting other than a practitioner’s office to Case Managers.
- Provides routine outbound call services for regional support.
- Demonstrates a basic understanding of all products for assigned region. Refers questions to Senior Customer Service Representative, Supervisor, or Case Manager as appropriate.
- Takes responsibility for completing assignments and bringing all outstanding issues to closure.
- Responsible for production and quality standards.
- Maintains complete and accurate system documentation of all customer interactions.
- Maintains documentation in member files according to standard policies and procedures.
- Maintains resource information at workstation including benefit designs, plan information, and practitioner directories.
- Demonstrates professionalism and presents a positive image of the company when interacting with members and providers.
- Demonstrates responsiveness and a sense of urgency when dealing with members and providers.
- Supports individual and team goals and initiatives; accepts ownership for individual results.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent.
- Previous customer service experience required, call center experience preferred.
- Previous keyboard/data entry experience required.
- Previous work experience in a computer-based office environment preferred.
- Must be able to navigate within a computer/systems-dependent environment without assistance;experience in a windows-based computer environment preferred.
- Knowledge of basic medical terminology preferred.
- Effective verbal and written communication skills.
- Demonstrated listening and interpersonal skills.
- Ability to absorb and apply new and changing information.
- Ability to remain calm and controlled in stressful, unexpected situations.
- Ability to tactfully work with confidential information.
- Ability to maintain regular and consistent attendance in accordance with company and departmental policies and procedures.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Administrative Support Workers
Primary Location: Austin, TX, US
Other Locations: St. Louis-Missouri-United States,Casselberry-Florida-United States
Organization: 51000 - MHNet Specialty Services, LLC
Schedule: Full-time
Job Posting: 2013-02-04 00:00:00.0
Job ID: 1310363