The customer service representative is responsible for registering health care services and for referring clients to the appropriate level of care after consulting with the Clinical Coordinator or Case Manager.
Records the services authorization and complies with the established processes to coordinate services with the providers.
Educates clients, their representatives and their dependents about the coverage benefits available and about community resources.
Answers the telephone in the company’s established time frame, with a clear and pleasant tone of voice, and with an appropriate language expression
Upon answering the telephone, FHC Call Center staff identifies him / her by name, title and organization’s name.
Shows appropriate communication skills, effective listening and management skills to deal with difficult clients
Conducts telephone interview to gather the necessary data, logs the health care services, coordinates appointments and makes the referrals
Educates the insured about our programs and coverage’s benefits
Verifies the member eligibility before processing and logging the phone call in the program
Complies with the guidelines and established criteria for the different processes
Demonstrate knowledge when using the program to log the health care services and the other technological applications available
Register the phone calls received in the appropriate platform
Conducts with the interview process and documents according to the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and law 408
Applies in a consistent manner the policies and procedures that are pertinent to the Access Center at FHC
Complies with the established quality parameters, abandonment rate and average speed of answer
Once a determination is made, completes the service authorizations and sends them to the provider
Interacts with members of the Integrated System to guarantee the efficiency and continuity of service
Manages the emergency calls according to the standard procedures established in the practice of mental health services and according to the internal policies and procedures established by the organization, which are relevant to the Access Center.
Minimum qualifications :
Bachelor of Sociology, Psychology, Social Work, Social Sciences, Register Nurse, or Health Educator
Licenses : Not required.
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