Jobs
>
Birmingham

    Patient Service Representative - Birmingham, United States - Highridge Medical

    Highridge Medical
    Highridge Medical Birmingham, United States

    2 weeks ago

    Default job background
    Upper Management / Consulting
    Description

    Job Summary:

    The Patient Services Representative's (PSR) primary responsibility is to verify eligibility, confirm benefits and process pre-authorization, if required, for all non-invasive bone stimulation devices. PSRs coordinate with our sales force to collect patient data and inform them when a device is OK to apply. If a pre-authorization denial is received, the PSR will be required to review the denial and determine if an appeal/reconsideration is necessary (meets medical criteria, etc.), to proceed with obtaining authorization prior to billing. As part of this process, the PSR must acquire all necessary information, pursuing all avenues to complete the order process efficiently and effectively.

    Principal Duties and Responsibilities:

    1. Examine all documentation received with new orders inclusive of patient demographics, clinical documentation, and other insurance related documents (i.e., authorizations, sales proposals, etc.) for accuracy and determination of insurance carrier medical criteria as it relates to non-invasive bone stimulation. Tasks carried out are specifically as follows:
    2. Demonstrate product knowledge in relation to the information being submitted.
    3. Review medical documentation and exhibit knowledge through accurate summarization in file, as it relates to medical necessity / insurance criteria for non-invasive bone stimulation.
    4. Demonstrate the ability to document all related job requirements in the FileNet database specifically as follows:
    5. Exhibit knowledge of workflow, including general knowledge of department workflow.
    6. All message documentation must be appropriate and reflect accuracy.
    7. Accurately identify the Sales Rep and prescribing physician for all orders being processed through accurate documentation and completion of corresponding FileNet fields.
    8. Accurately complete medical tab as supported by medical documentation.
    9. Accurately complete all tab requirements in relation to Sales commissions and payer requirements.
    10. FileNet Code knowledge as it relates to processing, workflow, and payer requirements (Insurance Type, Revenue Code, Policy Type, etc.).
    11. Accurately document Insurance benefits and authorization information.
    12. Summarize denial and appeals information.
    13. Contact the insurance carriers for verification of insurance eligibility and benefits and to initiate the pre-authorization process, if necessary. The following procedures are carried out, when determined to be applicable:
    14. Pursue retro-authorizations, when required.
    15. Identify, analyze and process appeals for denied pre-authorizations.
    16. Contact a Healthcare Policy & Payer Relations Director (RD) regarding contracting, criteria and pricing issues i.e., incorrect contract pricing, advise regarding non-contracted insurance carriers, constructing Letters of Agreement for non-contracted insurance carriers, etc.
    17. Act as the primary resource and liaison with the Sales Force and physician's office to collect, communicate, and deliver medical information and necessary forms, ensuring all required information submitted is accurate.
    18. Handle and advise on all requested escalated orders as it relate to their affiliated BPO team.
    19. Manage & maintain all documentation required for audit site visit.
    20. Required to meet all department goals set forth by management.
    21. Act as Liaison between the Customer, the Sales Force, and the Insurance carrier/payer.
    22. Provide excellent customer support to all business contacts, including the Sales Force
    23. Participates in team member, including BPO team member, training.
    24. Other job functions as determined necessary and as assigned by management.

    This is not an exhaustive list of duties or functions and may not necessarily comprise all of the "essential functions" for purposes of the ADA.

    Expected Areas of Competence (i.e., knowledge, skills, and abilities)

    • Knowledge or understanding of commercial insurance, Medicare, Medicaid, and other governmental and private insurance products, specifically the verification and authorization processes.
    • Medical terminology and health insurance background required.
    • Understanding on health insurance concepts and benefit design required
    • Excellent customer service skills, analytical problem-solving skills, strong written and verbal communication skills, professional telephone manner and well organized
    • Able to work with balancing team and individual responsibilities.
    • Experience using Microsoft Office tools such as Work and Excel
    • Ability to learn and use proprietary programs such as FileNet.

    Education/Experience Requirements

    • Associates degree or equivalent from a two-year college or technical school preferred
    • Minimum of 3-5 years' customer service experience and/or medical background

    Travel Requirements

    N/A

  • Nothing Bundt Cakes - Birmingham/Hoover

    Guest Service Representative

    5 days ago

    Nothing Bundt Cakes - Birmingham/Hoover Birmingham, United States

    At **Nothing Bundt Cakes**, we refer to our guest services representatives as **Joy Creators** A Joy Creator sweetens up the place, setting the mood and making a stop in the bakery an event worth posting about. You'll get to play party planner by helping guests order the right ca ...

  • Michael O'Neal - State Farm Agent

    Customer Service Representative

    5 days ago

    Michael O'Neal - State Farm Agent Birmingham, United States

    **Position Overview**: · Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the career for you State Farm agents market only State Farm insurance and fin ...

  • Cascade Innovations

    Sales Service Representative

    1 week ago

    Cascade Innovations Homewood, United States

    We are a successful savings bank in Lower Saxony. With personal advice and modern services, we are there for our customers throughout the district. The district and city offer a high quality of living and leisure and are located in close proximity to the Hanseatic and university ...

  • BL Harbert International

    Service Representative

    1 week ago

    BL Harbert International Birmingham, United States Full time

    Harbert International is seeking an Service Representative in Birmingham, Alabama. Candidate will be expected to be able to communicate with all layers of the company's organizational chart and over any communication medium (phone, in person, written, etc.). This is a departmenta ...

  • KO-RECRUIT

    Benefits Customer Service Representative

    5 days ago

    KO-RECRUIT Gardendale, United States

    We are in search of a dedicated individual to serve as a Benefits Representative for our customers. You will organize and issue benefit materials, participate in sales meetings, as well as answer all questions and issues related to benefits in a timely and professional manner. · ...

  • VCA Animal Hospitals

    Client Service Representative

    1 week ago

    VCA Animal Hospitals Birmingham, United States

    Client Service Representative · We are seeking an experienced Client Service Representative to join our team. · At VCA Animal Hospitals, we take our mission statement - your pet's health is our top priority and excellent service is our goal - very seriously. With every opportunit ...

  • VCA Animal Hospitals

    Client Service Representative

    1 week ago

    VCA Animal Hospitals Homewood, United States

    Client Service Representative · We are seeking an experienced Client Service Representative to join our team. · At VCA Animal Hospitals, we take our mission statement - your pet's health is our top priority and excellent service is our goal - very seriously. With every opportunit ...

  • VCA Antech, Inc.

    Client Service Representative

    1 week ago

    VCA Antech, Inc. Homewood, United States

    Client Service Representative · We are seeking an experienced Client Service Representative to join our team. · At VCA Animal Hospitals, we take our mission statement - your pet's health is our top priority and excellent service is our goal - very seriously. With every opportunit ...

  • Circle K Stores, Inc.

    Customer Service Representative

    10 hours ago

    Circle K Stores, Inc. Birmingham, United States

    Store : 1901 Finley, Birmingham, Alabama 35234 Availability - Shift/ Days Flexible Availability Customer Service Representative. We want you to join our team as a Customer Service Representative. If you have the desire to be challenged, work i Customer Service Representative, Cus ...

  • Qonten

    Customer Service Representative

    1 week ago

    Qonten Birmingham, United States

    **Customer Service Representative** · | Tue, 28 Dec :06:36 GMT · The Customer Service role is responsible for answering inbound customer calls, emails and chats. We are committed to providing equal employment opportunity in all areas, including but not necessarily limited to, r ...

  • Worldwide Executives

    Customer Service Representative

    1 week ago

    Worldwide Executives Birmingham, United States

    The consumer comes first within the hospitality industry and that is no exception at Worldwide Executives. Our Customer Service Representatives help the local neighborhoods by offering products and services from our various clientele to increase their brand awareness and communit ...

  • Circle K Stores, Inc.

    Customer Service Representative

    1 week ago

    Circle K Stores, Inc. Birmingham, United States

    Store : 2195 Hwy 150, Hoover, Alabama 35244 Availability - Shift/ Days Flexible Availability Customer Service Representative. We want you to join our team as a Customer Service Representative. If you have the desire to be challenged, work in a Customer Service Representative, Cus ...

  • Croda

    Customer Service Representative

    1 week ago

    Croda Birmingham, United States

    Customer Service Representative · Location: Birmingham, AL · Address: 800 Concourse Way, Birmingham, AL 35244 · Requisition:3820 · Position Summary: The Customer Service Representative will be required to be proficient in the day-to-day operations of customer service. An empl ...

  • The Encompass Group

    Customer Service Representative

    1 week ago

    The Encompass Group Birmingham, United States

    Client Service Representative Opportunity in Birmingham, AL · Want a company that invests in you rather than treating you like a number? Looking for a company that has direct growth plans? · We are looking for a high-level Client Service Representative to join a boutique firm h ...

  • Croda

    Customer Service Representative

    1 week ago

    Croda Birmingham, United States

    Customer Service Representative · Location: Birmingham, AL · Address: 800 Concourse Way, Birmingham, AL 35244 · Requisition: 3828 · Position Summary: The Customer Service Representative will be required to be proficient in the day-to-day operations of customer service. An emp ...

  • Circle K

    Customer Service Representative

    2 weeks ago

    Circle K Birmingham, United States

    Circle K - 232 Roebuck Plaza Dr [Retail Associate / Team Member] As a Customer Service Representative at Circle K, you'll: Provide prompt, courteous customer service and resolve customer issues on shift; Ring up all sales on cash register properly; Perform multi-function operatio ...

  • VCA Animal Hospitals

    Client Service Representative

    1 week ago

    VCA Animal Hospitals Birmingham, United States

    Client Service Representative · We are seeking an experienced Client Service Representative to join our team. · At VCA Animal Hospitals, we take our mission statement your pets health is our top priority and excellent service is our goal very seriously. With every opportunity, ...

  • Alabama Credit Union

    Member Service Representative

    1 week ago

    Alabama Credit Union Birmingham, United States

    ** Member Service Representative** · **Job Category****:** Operations/Service **Requisition Number****:** MEMBE001841 Showing 1 location **Job Details** · **Description** · At Alabama Credit Union, our employees feel good about their careers. We create an environment rich in l ...

  • Schulte Companies

    Guest Service Representative

    6 days ago

    Schulte Companies Birmingham, United States

    Schulte Companies th Ave S [Front Desk Agent / Concierge] As a Guest Service Representative at Schulte Companies, you'll: Greet guests and provide exceptional customer service; Handle guest inquiries and complaints; Process reservations and check-ins; Assist with luggage and tran ...

  • Crunch Fitness

    Member Services Representative

    2 days ago

    Crunch Fitness Birmingham, United States

    Crunch Fitness - JobID: [Guest Service / Front Desk] As a Member Services Representative at Crunch Fitness, you'll: Greet all members & guests with a smile; Check in all members and guests in accordance with company procedures; Communicate special events to members and guests; Fa ...