Electronic Case Opening Specialist

MedRisk LLC; Mandaluyong; On-site; PHP 223,000 - 446,000; Full time

Job summary

MedRisk LLC in Mandaluyong, Philippines, is seeking Customer Service Professionals (CSPs) for the Electronic team to support client retention and referral objectives. You will handle new EOC/case requests from Adjusters, Centers, Doctors, Patients and others, with electronic processing via email, fax, portals, and EDI.

Productivity and quality of work are emphasized, with compliance to HIPAA and URAC guidelines.

Qualifications

• Bachelor’s degree preferred or industry experience equivalent.
• Excellent verbal and written customer service skills demonstrating a can-do attitude.
• Highly developed problem-solving skills.
• Detail oriented and solid organizational skills.

Responsibilities

• Receive inbound electronic referrals from Adjusters, NCMs, Centers, MDs, patients etc.
• Open new EOCs/cases accurately according to policy and procedures.
• Review case information to determine if a new case needs to be opened or patient can be followed in existing case.
• Make first outbound attempts with various sources to verify new case/missing information, requesting Verification from Insurance Carriers or request other related paperwork telephonically
• Maintain productivity and quality EOC monitoring goals daily/monthly.
• Validate new case data by reviewing, correcting, deleting, or re-entering data; combining data when account information is incomplete.
• Phone trained CSPs with prior MedRisk Inbound call center experience will be called upon to assist with incoming calls during a time of crisis.
• Forward any email/fax to proper dept. Attachment documents appropriately to new/existing EOCs.
• Understand MedRisk’s interdepartmental procedures, policies and comply with them.
• Identify potential or existing system and/or procedural challenges, and notify Supervisor and assist in resolution if needed.
• Complete special projects or tasks as assigned by the supervisor.
• Compliance with HIPPA and URAC guidelines
• Other duties as assigned.

Skills

Customer service

Problem solving

Detail oriented

Organizational skills

Communication

Education

Bachelor’s degree preferred or industry experience equivalent

Tools

MS Word

Excel

Outlook

Job description

MedRisk LLC in Mandaluyong, Philippines, is seeking Customer Service Professionals (CSPs) for the Electronic team to support client retention and referral objectives. You will handle new EOC/case requests from Adjusters, Centers, Doctors, Patients and others, with electronic processing via email, fax, portals, and EDI.

Productivity and quality of work are emphasized, with compliance to HIPAA and URAC guidelines.