Medical Services Support Specialist I

1 week ago

Rochester, New York, United States Univera Healthcare Full time
Job Summary

We are seeking a highly skilled and detail-oriented Medical Services Support Specialist I to join our team at Univera Healthcare. As a key member of our operations team, you will play a vital role in supporting the workflow of our Medical Service and pharmacy departments.

Key Responsibilities
  • Access and manage patient information and management systems to facilitate inbound and outbound calls, ensuring high regard for member privacy and adherence to corporate policies and procedures.
  • Triage and resolve customer inquiries, ensuring problems are resolved to the customer's satisfaction within the required timeframe.
  • Provide assistance to patients in resolving various inquiries and identify potential Member and Disease Management opportunities to determine member interest in our programs.
  • Educate members on our Member and Disease Management programs and serve as a point of contact for problems stemming from Medical Services clinical documentation systems.
  • Identify and suggest solutions to system limitations to enhance various support functions and participate in trainings to learn regulations, claims systems, and develop skills.
  • Maintain high regard for member privacy and adhere to corporate policies and procedures.
  • Regular and reliable attendance is expected and required.
Requirements
  • LPN, Medical Assistant, Health Plan customer service or claims processor experience with a minimum of one year experience working in an insurance company or medical care setting required.
  • Minimum of one year of customer service experience preferred; preferably in a call center environment.
  • Knowledge of Federal/State regulations and requirements.
  • Working knowledge of medical terminology and the claims systems required.
  • Must possess operational and insurance knowledge.
  • Demonstrates proficiency in basic navigation and utilization of department-specific applications: care management system, department libraries.
  • Excellent oral and written communication skills.
  • Ability to multi-task in order to efficiently resolve customer concerns, by actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously.
  • Demonstrates role-specific competencies as it pertains to individual work unit on a consistent basis.
  • Excellent computer skills required, including the ability to navigate in a Windows environment, Lotus Notes understanding preferred and instant messaging and text message technology used regularly.
  • Strong organizational skills and ability to prioritize, multitask, and work in a fast-paced environment and remain professional and focused under pressures and demands.
  • Attention to detail.
  • Ability to work effectively as a member of a team.
Level II Requirements
  • Minimum of 1 year experience with both inbound and outbound calls.
  • Strong organizational skills and ability to prioritize, multitask, and work in a fast-paced environment.
  • Working knowledge of all Member and Disease Management programs.
  • Ability to triage calls.
  • Resolves customer inquiries across multiple lines of business.
  • Demonstrated proficiency navigating in a Windows environment.
  • Advanced skill working between multiple programs and applications simultaneously.
Level III Requirements
  • Minimum of 2 years experience with both inbound and outbound calls.
  • Ability to resolve customer inquiries across multiple plans with limited assistance.
  • Able to identify potential systematic issues and report as necessary without Team Lead/Supervisor assistance.
Physical Requirements
  • Must possess the ability to sit for long periods and view information on a computer monitor.
  • Some travel may be required.
  • Some work evenings or weekends may be required.

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