Customer Service Ops Support Specialist

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

JOB TITLE: Customer Service Operational Support

Location: Remote

DEPARTMENT: Customer Service/Intake

FLSA STATUS: Non-exempt

OVERVIEW: To support Customer Service Operations for all service products in all lines of business

ESSENTIAL DUTIES AND RESPONSIBILITIES :

• Process EOB Request in Document Manager Inbox.
• Completes outgoing Billing provider calls to request bill/medical records.
• Claim message handling all carriers.
• Solely maintain/address CSBilling mailbox inquires daily.
• Solely maintain/address CSIntake mailbox inquires daily.
• Distribute daily WC Hospital notifications- sent daily by supervisor.
• Complete daily FROI report and send to WCMC by 2pm daily (Back only)
• Research and distribute Request for Precert (RFP Inbox) forwarding back to Precert, Carrier or provider.
• Specialize process Allstate NIS/ Precert request.
• Enter and distributes FROIs as assigned.
• Enters new Intake/Referrals into SYSTEM.
• Advises Customer Services/Intake Supervisor of activities and problematic issues.
• Utilizes various department Trackers (Productivity, Billing Tracker, Email) to track daily production.

• Login as “New Login” to CCS to be available as back up phone agent.

• FROI Mailbox distribution/Q&A (back up)
• Process updates to PE List, Employer Manager.
• Maintenance of FROI Right Fax address book.
• Can Assist with training.

• Completes other tasks as assigned by Customer Service/Intake Supervisor

KNOWLEDGE:

• Knowledge of daily customer service operations and principles, including customer needs assessment, meeting quality standards for services and evaluations of customer satisfaction.

• Knowledge of corporate and departmental policies and procedures.
• Possess’ working knowledge of pre-cert, worker’s comp, group health, PPO lookup, and Bill Review process.

• Knowledge of insurance carrier plans
• Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, designing forms and other office procedures and terminology.

• Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition and grammar.

• Knowledge of computer hardware and software
• Knowledge of medical coding, i.e., CPT codes, ICD-9 codes, HCPCS codes
• Knowledge of office equipment, i.e., telephone, computer, fax machine, copy machine, printer, e-copy scanner, calculator.

SKILLS

• Bilingual Spanish highly preferred.

• Must have moderate analytical skills, to sift through verbal and written information in order to make a decision in relation to the problem presented.
• Must be able to remain focused on the issue at hand without digressing to non-related matters.

• Monitor and assess own performance and make improvements and or take corrective action.

• Excellent Communication Skills
• Excellent Computer/Data Entry Skills

EDUCATION, EXPERIENCE AND TRAINING:

• High School Diploma required.
• College Diploma or Certified Course Work preferred.
• Minimum of two years Customer Service experience required.
• Managed Care, Health Care, Doctors’ office/facility experience preferred.
• PHYSICAL DEMANDS: None must be carried out by an employee to successfully perform the essential functions of this.

EEOC STATEMENT:

Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.