Concierge/RBP Precertification Representative Part Time
Scope: The Reference-Based Pricing Customer Service Representative will play a crucial role in ensuring the satisfaction and retention of our members by providing timely and accurate assistance with their healthcare inquiries and concerns. This role requires a strong understanding of reference-based pricing models, healthcare billing processes, and exceptional customer service skills to effectively communicate with members and resolve issues in a professional and efficient manner. This is a part-time position, 9:00 am - 2:00 pm, 25 hours per week
Education:
Minimum HS Diploma/GED, 2 years college or higher education preferred; Experience considered without higher education.
Licensure/Certification Requirements:
None
Experience:
1 year of customer service experience in a call center environment
1 year of experience in a patient facing customer service role in a medical setting
Requirements/Skills:
Strong customer relations skills
Accurate data entry and computer navigation
Understanding of RBP/Open Access Plans and able to explain plans to medical staff at both Physician offices and facilities.
Excellent verbal and written communication skills
Knowledge of CMS Medicare reimbursement rates
Understanding of Self-Funded health benefits a plus
Ability and patience to handle difficult situations tactfully and diplomatically.
Resolve situations and complete tasks.
Able to make decisions and problem solving.
Ability to multi-task.
Strong attention to detail.
Strong computer skills.
Strong analytical and research skills.
Duties and Responsibilities:
Performing pre-pricing estimates using tools provided.
Validate and send out appropriate pre-certification letters.
Negotiate with providers to gain acceptance for plans without network agreements and/or out of network providers.
Educate providers on the reference-based pricing model, including how it works and reimburses for services.
Provide steerage to providers that accept Reference Based Pricing Health Plans.
Maintain accurate and detailed records of interactions and resolutions in our databases.
Collaborate with internal teams to address member inquiries and ensure timely resolution of issues.
The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice.
Pay range for this position is $16.50 - $17.50 hourly.
Work Environment / Physical Demands: This position is in a typical office / home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.
We are an Equal Opportunity Employer including disability/veterans.