Call Center Specialist

<p><strong>Must be located in central time zone</strong></p><p><br></p><p>This position primarily handles outbound call queues for designated clients related to authorization processing for multiple medical specialties and products. This may include notification calls to ordering physicians, imaging facilities and members, as well as other benefit related calls. This position is held accountable for meeting individual productivity and quality metrics and working with a team to meet compliance and timeliness targets for our clients. This role is cross trained in inbound functions and provides back up support to Providers Services Coordinator as required.</p><p><br></p><p> Contacts referring physicians' offices, members and imaging providers via telephone to communicate authorization approvals, denials and appeals information for a wide range of medical products, while maintaining confidentiality.</p><p> Recognizes the compliance and regulatory requirements for each health plan and each medical product and assures actions meet these requirements.</p><p> Contacts referring physicians' offices via telephone to verify authorization information, obtain additional clinical information or facilitate a peer-to-peer consultation between ordering physician and a SBU Physician Reviewer.</p><p> Documents every outreach call with appropriate actions and notes to support contracted and compliance requirements and clarity about each interaction or attempt to interact.</p><p> Makes outbound calls to members to support SBU's Facility Scheduling Program.  Understands the end-to-end authorization process, SBU's business and business drivers for success.</p><p> Resolves provider or member concerns as the first line of contact.</p><p> Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.</p><p> Transfers calls to clinicians and physicians only for clinically escalated situations.</p><p> Processes withdrawals and other case status changes as needed.</p><p> Recognizes and develops relationships with provider groups through repeat calls and recognizes provider sensitivities for different health plans.</p><p> Supports team members and participates in team activities to help build a high-performance team.</p><p> Demonstrates flexibility in areas such as job duties and schedule in order to aid SBU's Customer Care Operations in better serving its members and help SBU achieve its business and operational goals.</p><p> Assists SBU efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.</p><p> Assumes responsibility for self-development and career progression.</p><p> Meets SBU's service standards in all categories on a monthly basis, being a team player, maintaining member and provider confidentiality at all times, demonstrating effective problem-solving skills, and being punctual and maintaining good attendance.</p><p> Electronically attaches incoming clinical faxes to authorization requests for medical studies.</p><p> Works timeliness reports and CAPS report email.</p><p> Collects after hours voice messages, research questions, triages case to the appropriate team and/or return calls as needed.</p><p> Reads and retains updated account information disseminated through multiple sources. Calls are handled accurately and appropriately, aligned with current health plan and internal policy requirements.</p><p> Manages Coordinator Help Inbox to resolve non-standard case issues.</p><p> Assists with researching unmatched or errant faxes to protect member PHI and identify system issues and training opportunities for team members.  Requests to clear notifications manually as part of daily timeliness efforts to meet Performance Guarantees.</p><p> Other duties as assigned by management.</p><p><br></p><p>The Experience You’ll Need</p><p>⦁ High school diploma or GED</p><p>⦁ At least 1 year call center experience</p><p>⦁ Ability to handle a heavy call volume of 50-100 calls daily</p><p>⦁ Ability to maintain strict confidentiality of protected health information</p><p>⦁ Demonstrated ability in using computer and Microsoft applications, which includes strong keyboard and navigation skills, ability to type 35 WPM and learn new computer programs</p><p>⦁ Ability to work regularly scheduled shifts within hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over time and/or weekends, as needed</p><p>⦁ Demonstrated ability to take an educative approach, listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the customer, answering questions and informing of health plan policies, procedures, or decisions Additional</p><p><br></p><p>Experience that is Preferred</p><p>⦁ 2+ years at a health plan, TPA or related call center setting</p><p>⦁ Knowledge of managed care, Commercial, Marketplace, Medicaid and/or Medicare programs; knowledge of medical policy benefits and exclusions</p><p>⦁ Bilingual in Spanish & English (validated via bilingual assessment upon offer acceptance)</p>