Universal Agent Customer Service Rep

SHR (Spectrum Healthcare Resources); Denver (CO); Remote; USD 40,000 - 50,000; Full time

Job summary

Join a leading healthcare provider as a Universal Agent Customer Service Representative, working remotely to ensure optimal beneficiary care. This role involves assessing care needs, managing referrals, and collaborating across various healthcare specialties. Ideal candidates possess strong communication skills and relevant healthcare experience.

Qualifications

• 2+ years’ experience in a healthcare customer service environment.
• Knowledge of medical terminology preferred.
• Managed Care experience and TRICARE experience preferred.

Responsibilities

• Assess beneficiaries to identify medical, physical, and psychosocial needs.
• Document correspondence via the medical management system.
• Process referrals for various healthcare needs.

Skills

Communication

Organizational skills

Technical aptitude

Education

High School Diploma or G.E.D.

Tools

Microsoft Office

Job description

Join to apply for the Universal Agent Customer Service Rep role at SHR (Spectrum Healthcare Resources).

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Job Description

Spectrum Healthcare Resources has a potential need for a Universal Agent Customer Service Representative. These are completely remote positions, working entirely from the Universal Agent's home. The Customer Service Representative will help ensure all aspects of beneficiary care are met by working with different departments or individuals across multiple locations and specialties. The Universal Agent will work Monday through Friday, 8 hours per day.

Requirements

• High School Diploma or G.E.D.
• 2+ years’ experience in a healthcare customer service environment
• Experience with Microsoft Office
• Preferred:
• Knowledge of medical terminology
• Managed Care experience
• TRICARE experience

Key Responsibilities

• Assess beneficiaries to identify medical, physical, and psychosocial needs to support their overall care goals.
• Assess tasks for authorization/referral requests to ensure accurate entry into the medical management system.
• Identify potential discrepancies in the medical management system to ensure quality compliance.
• Meet department productivity and performance metrics consistently.
• Document receipt of returned correspondence via the medical management system.
• Follow HIPAA compliance and confidentiality guidelines.
• Refer beneficiaries to network providers.
• Resolve issues to complete care requests.
• Read communications detailing diagnoses and requested services and procedures.
• Assist in producing trend reports to improve workflow efficiency and system functions, and recommend solutions to management.
• Resolve data quality issues by identifying, documenting, and communicating them.
• Address process issues to ensure high-quality service levels and escalate as needed.
• Process referrals for Behavioral Health, Specialty Care, Durable Medical Equipment, Inpatient Admissions, Military Treatment Facilities, and urgent requests, ensuring proper entry into the system using coding systems like ICD-10, CPT, and HCPCS.
• Be highly organized and able to function in a high-volume environment without distractions.
• Possess strong verbal and written communication skills.
• Have proficient experience with Microsoft Office and strong technical aptitude.
• Must have access to secure, high-speed internet.

Company Overview

Spectrum Healthcare Resources (SHR) was established in 1988 to meet the unique needs of Military and VA Health Systems. SHR provides staffing and management services to Military Treatment Facilities, VA clinics, and other Federal Agencies. It is a Joint Commission-accredited firm and the military staffing division of TeamHealth, serving numerous hospitals with thousands of healthcare professionals.

EOE/Disabled/Veterans

Location: US-CO-Denver

Recruiter: Joseph Day

Contact: 314-744-4138 | [e-mail]

Seniority level: Entry level

Employment type: Full-time

Job function: Other

Industries: Hospitals and Health Care