Healthcare Provider Support Specialist

MCS Puerto Rico; San Juan (PR); Sur place; USD 32 000 - 48 000; Plein temps

Résumé du poste

MCS Healthcare Holdings, LLC in Puerto Rico seeks a Customer Service Representative to answer and make provider and member inquiries, ensuring issues are resolved at the first point of contact and escalating when needed.

Responsibilities include documenting complex benefit inquiries, supporting multiple provider types, maintaining HIPAA compliance, and educating providers on platform tools, with rotating shifts including weekends and holidays.

Qualifications

• Educational options per ad: Bachelor's degree; or 60 credits with 1+ year CS in health insurance; or high school diploma with 2+ years CS.
• Familiarity with medical billing is preferred.
• Availability to work rotating shifts, including Saturdays, Sundays, and holidays.

Responsabilités

• Documents, investigates, and facilitates resolution of complex inquiries related to benefits interpretation, provider configurations, claim edits, eligibility determinations, and COB.
• Serves as the primary point of contact for provider-related service inquiries and issues for participating and non-participating providers.
• Maintains HIPAA and data privacy compliance in all customer interactions and system usage.
• Educates providers and staff on provider platform tools, including system access, account creation, access recovery, and functionalities.
• Provides feedback and participates in continuous improvement initiatives to enhance service quality.
• Adheres to call center processes, KPIs, and scripts to ensure consistent service delivery.

Connaissances

Customer Service

Telephone Etiquette

Keyboarding

Spanish (Intermediate)

English (Intermediate)

Formation

Bachelor's Degree

60 college credits

High School Diploma

Description du poste

MCS Healthcare Holdings, LLC in Puerto Rico seeks a Customer Service Representative to answer and make provider and member inquiries, ensuring issues are resolved at the first point of contact and escalating when needed.

Responsibilities include documenting complex benefit inquiries, supporting multiple provider types, maintaining HIPAA compliance, and educating providers on platform tools, with rotating shifts including weekends and holidays.