Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Medicare Customer Service Associate
- 📁
- Operations
- 💼
- ConnectiCare
- 📅
- Sep 16, 2019 Post Date
Summary: To provide telephonic customer service to members, providers and facilities.
Responsibilities:
• Receives and responds to telephone calls and correspondence from members, regarding billing, benefits, coverage, payment, coding, and health services policies and procedures.
• Maintains telephone log documenting number, content and type of calls received.
• Explains medical pre-authorization requirements and disposition of pre-authorization requests, as necessary.
• Researches and analyzes recurring billing and eligibility problems/complaints to determine root causes and trends.
• Collaborates with Management to identify areas of member/participant dissatisfaction and trends concerning membership or benefits.
• Researches and analyzes recurring member problems/complaints to determine root causes and trends; recommends solutions and/or resolutions.
• Provides instruction to members for submitting out-of-plan medical claims.
• Acts as customer advocate in providing assistance to resolve callers' issues and problems.
• May provide instruction to members for obtaining prior approval on benefits that have certain restrictions.
• Investigates requests for claims adjustments by callers and collaborates with Claims teams to ensure claims adjustments have been made. Follows thru w/callers by communicating when/if adjustments can not be made.
• Performs other related projects and duties as assigned.
Qualifications:
• Post High School education/training or equivalent combination of education and experience.
• At least 2 years of previous customer service experience in a medical office, sales/service or billing environment required; telephonic customer service experience preferred.
• Knowledge of Medicare Regulations/Product, ICD-9 and ICD-10 diagnosis, CPT-4, UB82 revenue codes, UB92 revenue coding and procedural coding desired.
• Excellent oral and written communication skills and interpersonal skills required.
• Previous system user experience in a highly automated environment required. Strong personal computer skills.
• Demonstrated analytical skills desirable.
• Excellent telephone manner; ability to handle high volume of calls efficiently and courteously.
• Ability to perform in office environment with extended periods of sitting, using telephone, viewing computer screens, standing, reaching, lifting files, binders, computer reports.
ESSENTIAL JOB REQUIREMENTS:
• Primarily sedentary
• Must be able to use standard office equipment
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, Emblemhealth may provide work visa sponsorship for certain positions.