Customer Service Liaison

1 day ago

Green Bay, Wisconsin, United States Advocate Health Full time
Job Summary:

As a Customer Service Coordinator at Advocate Health, you will play a vital role in ensuring the smooth transition of patients from hospital to home while ensuring their safety and insurance benefits are optimized. You will be the liaison between patients, physicians, and insurance companies, explaining prescription orders, hospital transitions, and home start of care processes. Your attention to detail and ability to navigate complex medical documentation will be essential in verifying patient insurance benefits and eligibility. You will also provide direction to physicians on how to resolve documentation or medical management gaps. If you have a passion for delivering exceptional customer service and are skilled in navigating the complexities of healthcare, we encourage you to apply for this exciting opportunity.

Key Responsibilities:

  • Evaluate HME referral and service order requests to ensure timely transition for patients from hospital to home.
  • Advocate for patients as a liaison to explain prescription orders, hospital transitions, and home start of care processes.
  • Verify patient insurance benefits and eligibility and contact insurance plans to obtain service prior authorization as needed.
  • Provide direction to physicians on how to resolve documentation or medical management gaps.
  • Identify risk issues and collaborate with patients, physicians, hospital staff, and other care providers to ensure resolution and patient safety.
  • Coordinate timely provision of service with distribution operations and the patient.
  • Provide quality customer service for all customers, including patients, physicians, referral sources, and coworkers within Advocate Health and external customers.
  • Be proficient in the use of computerized resources and data entry programs involving proper processing and qualifying of patients with HME business line needs.
  • Monitor and work all necessary insurance verification reports for assigned product lines and assigned payors.
  • Identify, investigate, and verify sources of reimbursement and make recommendations based on the information obtained.
  • Provide pricing information to explain the financial responsibility to patients.
  • Participate in performance improvement and patient satisfaction initiatives.
  • Continuously update knowledge of Medicare, Medicaid, HMO, and managed care of the complex and ever-evolving coverage requirements and guidelines.

Requirements:

  • Typically requires 5 years of experience in medical entry, claims processing, HME business line, home care, insurance verification, home care customer service, or other healthcare-related positions.
  • Knowledge of HME/RT equipment and understanding of third-party payors, including Medicare, Medicaid, and private insurance companies.
  • Strong communication and interpersonal skills, with the ability to interface with representatives of third-party payers and a wide range of contacts with hospitals, long-term care facilities, rehab and therapy facilities, physician's offices, case managers, utilization review managers, patients, and their families.
  • Ability to prioritize insurance verification and prior authorization to ensure department goals and objectives are obtained.
  • Ability to monitor all managed care patients' supply orders and re-orders to ensure adequate and current authorization is in the database.
  • Ability to troubleshoot equipment problems and handle confidential information on every client.
  • Ability to function under tight time constraints to verify insurance benefits before delivery of equipment and data entry of referral information necessary for delivery tickets with proper qualifying diagnoses for each piece of ordered equipment.
  • Heavy volume of daily incoming and outgoing phone calls and documents must be processed timely and accurately.

Physical Requirements and Working Conditions:

  • Exposed to an office environment.
  • Must be able to sit, stand, and walk for long periods of time.
  • Must have the physical agility to move about in confined spaces, including bending, kneeling, squatting, and occasionally reaching one or both arms over head.
  • Must be capable of typing, writing, and data entry for prolonged periods of time.
  • Will occasionally lift 10 lbs.
  • Operates all equipment necessary to perform the job.

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