Tittle: Customer Service Representative
Location: Remote
Job Type: Full Time
Job Description – CSR Role
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am -8:00pm CST. It may be necessary, given the business need, to work occasional overtime. We will also be open on all holidays
The hours during training will be aligned with your schedule, Monday - Friday. Training will be conducted virtually from your home.
Primary Responsibilities:
1. Answer incoming calls from healthcare providers (physician offices, clinics, hospitals, and ancillary providers) regarding prior authorization requests, authorization status, and related inquiries.
2. Create and process prior authorization requests by accurately capturing required member, provider, service, and clinical information in the system while ensuring completeness and compliance with established guidelines.
3. Review authorization requests, verify required documentation, and facilitate appropriate routing for clinical review when necessary.
4. Research authorization status, navigate multiple systems to provide accurate updates, and strive to resolve provider inquiries during the first contact whenever possible.
5. Educate providers on prior authorization requirements, submission processes, turnaround times, and supporting documentation requirements.
6. Maintain accurate and detailed records of provider interactions, authorization activities, and follow-up actions to support reporting, compliance, and quality standards.
7. Deliver exceptional customer service by communicating professionally, building positive provider relationships, and ensuring a seamless provider experience.
This role is equally challenging and rewarding. You'll interact with providers with the intent to develop a relationship with them. Within a high volume setting, you'll need to develop knowledge of our various products and multiple levels of benefits within each product in order to best assist our providers/customers.
Qualifications - External
Required Qualifications:
· High School Diploma / GED OR equivalent work experience
· Experience with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
· Should be computer proficient and have minimum typing speed of 35 WPM with 92% accuracy
· Experience listening skillfully, collecting relevant information, building rapport and responding to customers in a compassionate manner
· Skilled in problem solving to quickly assess current state and formulate recommendations
· 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
· Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am -8:00pm CST. And on all holidays. It may be necessary, given the business need, to work occasional overtime
Preferred Qualifications:
· Health care experience
· Prior Auth Experience
