Customer Service Rep II - PHC

Customer Service Representative

This employee serves as the subject matter expert in all Customer Service responsibilities, primarily responsible for accurately, thoroughly, and in a time-sensitive manner, processing patient orders and providing clear and timely communication to all stakeholders.

1. Responds to telephone inquiries and orders from patients and referral sources
2. May assist walk-in patients with the selection of equipment, supplies, and services
3. Determines resolution of patient and referral inquiries, questions, or concerns
4. Identifies concerns and ensures they are recorded in Concern Tracker system when appropriate
5. Completes electronic intake process in billing system, performs verification of insurance, and reviews all documentation for accuracy in order to qualify patient for services
6. Contacts patients to inform them of any patient payment requirements, collects payment, and determines best delivery method, providing instructions for receiving delivery
7. Understands and abides by Accreditation Commission for Health Care (ACHC) requirements
8. May need to understand and interpret Medicare guidelines and qualifying documentation
9. Thoroughly understands payer and utilization guidelines
10. May process insurance authorization and follow up on requests as needed
11. Establishes positive relationships with referral sources and builds rapport with internal and external customers
12. May be required to perform quality assurance process, confirming accuracy of orders prior to submission for reimbursement
13. Understands C-PAP compliance guidelines as required by assignment, or has obtained knowledge of rehab specialty equipment and coverage criteria
14. Consistently meets Quality Assurance score of 85% or above