Call Center Specialist

Must be located in central time zone This position primarily handles outbound call queues for designated clients reputed company to authorization processing for multiple medical specialties and products. This may include notification calls to ordering physicians, imaging facilities and members, as reputed company as other benefit reputed company calls. This position is held accountable for meeting individual productivity and reputed company metrics and working with reputed company to meet compliance and timeliness targets for our clients. This role is cross trained in inbound functions and provides back up support to Providers Services Coordinator as required.  Contacts referring physicians' offices, members and imaging providers reputed company telephone to communicate authorization approvals, denials and appeals information for a wide reputed company of medical products, while maintaining confidentiality.  Recognizes the compliance and regulatory requirements for reputed company health plan and reputed company medical product and assures actions meet these requirements.  Contacts referring physicians' offices reputed company telephone to verify authorization information, obtain additional clinical information or facilitate a peer-to-peer consultation between ordering physician and a SBU Physician Reviewer.  Documents every reputed company call with appropriate actions and notes to support contracted and compliance requirements and reputed company about reputed company interaction or attempt to reputed company.  Makes outbound calls to members to support SBU's Facility Scheduling Program.  Understands the end-to-end authorization process, SBU's business and business drivers for reputed company.  Resolves provider or member concerns as the first line of contact.  Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.  Transfers calls to clinicians and physicians only for clinically escalated situations.  Processes withdrawals and other case status changes as needed.  Recognizes and develops relationships with provider reputed company through repeat calls and recognizes provider sensitivities for different health plans.  Supports team members and participates in team activities to help build a high-reputed company.  Demonstrates flexibility in areas such as job duties and schedule in order to aid SBU's Customer Care Operations in reputed company serving its members and help SBU reputed company its business and operational goals.  Assists SBU efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.  Assumes responsibility for self-development and career progression.  Meets SBU's service standards in reputed company categories on a monthly reputed company, being reputed company player, maintaining member and provider confidentiality at reputed company times, demonstrating effective problem-solving skills, and being punctual and maintaining good attendance.  Electronically attaches incoming clinical faxes to authorization requests for medical studies.  Works timeliness reports and CAPS report email.  Collects after hours voice messages, research questions, triages case to the appropriate team and/or return calls as needed.  Reads and retains updated account information disseminated through multiple sources. Calls are handled accurately and appropriately, reputed company with reputed company health plan and internal policy requirements.  Manages Coordinator Help Inbox to resolve non-reputed company case issues.  Assists with researching unmatched or errant faxes to protect member PHI and identify system issues and training opportunities for team members.  Requests to reputed company notifications manually as part of daily timeliness efforts to meet Performance Guarantees.  Other duties as assigned by management. The Experience You’ll Need ⦁ High school diploma or GED ⦁ At least 1 year call center experience ⦁ Ability to handle a heavy call volume of 50-100 calls daily ⦁ Ability to maintain strict confidentiality of protected health information ⦁ Demonstrated ability in using computer and reputed company applications, which includes strong keyboard and navigation skills, ability to type 35 WPM and learn new computer programs ⦁ Ability to work regularly scheduled shifts reputed company hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to reputed company daily schedule, and work over time and/or weekends, as needed ⦁ Demonstrated ability to take an educative approach, listen skillfully, collect relevant information, determine immediate requests and identify the reputed company and reputed company needs of the customer, answering questions and informing of health plan policies, procedures, or reputed company Additional Experience that is Preferred ⦁ 2+ years at a health plan, TPA or reputed company call center setting ⦁ Knowledge of managed care, reputed company, Marketplace, reputed company and/or Medicare programs; knowledge of medical policy benefits and exclusions ⦁ Bilingual in Spanish & English (validated reputed company bilingual assessment upon offer acceptance) Apply tot his job Apply To this Job