As a Customer Service Specialist, you will play a key role in supporting patient care by managing communication, processing orders, and ensuring insurance requirements are met. You'll handle inbound and outbound calls and emails, providing clear, accurate information about services, coverage, and financial responsibilities.
Key Responsibilities
- Respond promptly to customer inquiries via phone and email, following established service standards
- Process orders, verify insurance eligibility, and confirm coverage details including deductibles and co-insurance
- Obtain necessary pre-authorizations and submit physician orders to insurance providers when required
- Review and validate documentation for accuracy and compliance with payer guidelines
- Enter and maintain up-to-date records in electronic medical record (EMR) systems, including authorizations and expiration dates
- Identify and report recurring insurance-related trends to supervisors
- Contact patients when documentation is incomplete, offering guidance to move referrals forward
- Collaborate with internal teams to resolve complaints and improve service delivery
- Follow quality assurance protocols and meet performance benchmarks consistently
Qualifications
A high school diploma or equivalent is required. Candidates should have at least one year of experience in healthcare administration, insurance services, billing, or a call center environment. Senior-level applicants need two years of relevant experience, including one year performing similar duties within a Medicare-certified setting.
Prior knowledge of Medicare, Medicaid, and commercial insurance processes is preferred. Proficiency with EMR systems and tools such as NPI and PECOS databases is essential. Strong organizational skills, active listening, and the ability to manage sensitive situations with empathy are critical to success.
Work Environment
This role offers flexibility in both work hours and location, supporting a dynamic workflow. You must be comfortable using multiple digital platforms and company resources to maintain accuracy and efficiency. The ideal candidate is self-motivated, adaptable, and committed to delivering reliable, patient-centered service.
