Summary

Customer service professional responsible for answering claims and eligibility-related questions from physicians, hospitals, and other medical providers that participate in Rhode Island Medicaid. Some self-research for policy-related requirements using Medicaid-provided resources and the Medicaid website for your learning as well.

Responsible for follow-up and call resolution including callbacks and closing call references.

Excellent verbal communication skills are required along with asking fact-finding questions. Reference material is available for your call support allowing for excellent customer service with solid responses. Follow up required with providers as necessary. Detailed notes are needed for call references.

Additionally, providing updates to members on Benefit Plan Choice Selection and Premium payment status on the Adult Managed Care line.

Answering customer inquiries to ensure processing is following billing procedures. Follow up with supervisor on more complex, non-routine customer inquiries, including member requests and concerns.

Your role in our mission

Previous medical or medical billing experience is a plus, but not necessary.

Responsibilities:

• Answer an estimated 40-50 inbound calls daily from the Rhode Island Medicaid provider network and member beneficiaries. Providing excellent oral communications with quality customer service. Follow through and resolve all calls.
• Address billing and eligibility questions with your commitment to follow up as necessary to resolve.
• Create and manage computer call logs/references for added review and follow-up with solid outcomes.
• Provide excellent customer service including offering added assistance as appropriate. This includes becoming familiar with web service offerings to support and direct a provider to these offerings.
• Train and support peers and new team members
• Offline work
  • Quality Control of provider Enrollment for all aspects of enrollment entries
  • Claim Resolutions completed weekly sent by Claims Supervisor

What we're looking for

• Two years or more of customer service experience, either face-to-face or by phone.
• Detail oriented
• Prompt and reliable
• Good typing and computer skills
• Excellent verbal communication and Customer Service skills
• Minimum of a high school diploma or GED.
• Previous customer service experience in a professional setting.

What you should expect in this role

• The hours are full-time, Mon-Friday – 8:30 am -5:00 pm
• Candidate must be local and willing to come to the office every day for the first month or so of training. Once trained they will be in the office 2 days a week.