Universal Agent Customer Service Rep

Spectrum Healthcare Resources; Denver (CO); Remote; USD 35,000 - 50,000; Full time

Job summary

Spectrum Healthcare Resources is seeking a Universal Agent Customer Service Representative for a remote position in Denver, Colorado. The role involves assisting beneficiaries with their care needs and collaborating with various departments. Candidates should have a high school diploma and relevant experience in healthcare customer service.

Qualifications

• 2+ years' experience in a healthcare customer service environment.
• Prefers knowledge of medical terminology and managed care experience.

Responsibilities

• Assess beneficiaries' medical, physical, and psychosocial needs.
• Evaluate authorization/referral requests.
• Meet department productivity and performance metrics consistently.

Skills

Communication

Organization

Technical aptitude

Education

High School Diploma or G.E.D.

Tools

Microsoft Office

Job description

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 collaborating 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
• Evaluate 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 TriWest 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
• Ensure high-quality service levels throughout TriWest, escalating issues as needed
• Process referrals for Behavioral Health, Specialty Care, Durable Medical Equipment, Inpatient Admissions, Military Treatment Facilities, and urgent requests. Assess electronic documents for accurate entry, and work with coding systems including ICD-10, CPT, and HCPCS codes

• Highly organized, self-directed worker capable of functioning in a high-volume environment without distractions
• Strong verbal and written communication skills
• Proficient in Microsoft Office applications with strong technical aptitude
• Access to secure, high-speed internet

Company Overview:

Spectrum Healthcare Resources (SHR), established in 1988, delivers systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR provides physician and clinical staffing and management services to U.S. Military Treatment Facilities, VA clinics, and other Federal Agencies through various contracts. A Joint Commission-accredited Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, serving 850 civilian and military hospitals with 9,600 healthcare professionals nationwide.

EOE/Disabled/Veterans

Location

US-CO-Denver

Recruiter

Joseph Day

Phone

314-744-4138

Email

[e-mail]