Experienced Customer Service Representative - Health Plan Services at blithequark

Join blithequark: Delivering Exceptional Customer Experiences in Healthcare At blithequark, one of the fastest-growing Independent Physician Associations in Southern California, we're revolutionizing the healthcare landscape. Our mission is to provide high-quality, patient-centered care, and we're seeking a skilled Customer Service Representative to join our dynamic team. As a key member of our Member Services team, you'll be the face of blithequark, ensuring a seamless and positive experience for our members and Health Plans. About the Role As a Customer Service Representative at blithequark, you'll be responsible for providing top-notch administrative support and resolving customer inquiries via phone, email, or other channels. Your exceptional communication skills, empathy, and problem-solving abilities will be essential in addressing the diverse needs of our members and Health Plans. You'll work in a fast-paced environment, handling multiple tasks and prioritizing your work to maintain a high level of productivity. Key Responsibilities Respond to incoming calls from members and Health Plans, providing information and clarification on RMG/LMG services, such as authorizations, member billing, referrals, and eligibility. Maintain or exceed quality and productivity standards, handling a minimum of 35 calls per day with accurate documentation. Anticipate and address member needs, utilizing standardized processes and tools, such as EZCAP 6X and REA/LEA Systems. Resolve routine or complex issues related to services received within the medical group, including eligibility, authorization status, provider access issues, and member billing. Document all interactions in the EZCAP 6X customer service module and REA/LEA systems. Provide essential information to members regarding authorizations, billing issues, eligibility, and urgent cares. Maintain patient confidentiality, following HIPAA and PHI processes. Ensure department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations. Access Interpretation language line for non-English patients as needed. Demonstrate professionalism, a warm and pleasant phone personality, and excellent judgment. Prioritize work, manage your workflow, and maintain a high level of productivity. Requirements and Qualifications To succeed in this role, you'll need: A minimum of 2 years of customer service experience, preferably in a healthcare setting. Multi-line telephone experience and excellent communication skills, both verbal and written. A High School Diploma or equivalent. The ability to deal responsibly with confidential matters and maintain patient confidentiality. Proficient typing skills (45 WPM) with accuracy. Strong organizational skills, with an emphasis on prioritizing and attention to detail. Knowledge of MS Office programs (Word, Excel, Outlook, Access, and PowerPoint). Familiarity with computers, faxes, printers, and other office equipment. The ability to review and interpret health plan benefits and provider contracts. Preferred Qualifications Experience working in a fast-paced, dynamic environment. Knowledge of CPT, HCPCS, and other healthcare-related codes. Previous experience with customer service software and technology. What We Offer At blithequark, we're committed to providing a comprehensive benefits package that supports the well-being of our employees. Our benefits include: Competitive hourly rate ($20-$21 per hour). A sign-on bonus and discretionary awards. Medical, pharmacy, and dental insurance. Vision insurance and zero co-payments for employed physician office visits. Flexible Spending Account (FSA) and Employer-Paid Life Insurance. Employee Assistance Program (EAP) and Behavioral Health Services. 401(k) Retirement Savings Plan and Income Protection Insurance. Vacation time, sick days, paid holidays, and mileage reimbursement. Tuition Reimbursement and License Renewal CEU Cost Reimbursement Program. A business-casual working environment and opportunities for career growth. Career Growth and Development At blithequark, we're dedicated to nurturing the growth and development of our employees. As a Customer Service Representative, you'll have opportunities to: Develop your skills in a fast-paced, dynamic environment. Take on new challenges and responsibilities. Advance your career within the organization. Participate in training and development programs. Our Culture At blithequark, we pride ourselves on our welcoming and supportive work environment. We promote teamwork, encourage learning, and foster a culture of excellence. Our employees are our greatest asset, and we're committed to providing a work environment that is inclusive, engaging, and rewarding. Join Our Team If you're a motivated and compassionate customer service professional looking for a new challenge, we want to hear from you. Apply now to join our team at blithequark and be part of a dynamic organization that's shaping the future of healthcare. As an equal opportunities employer, blithequark considers qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance. Apply for this job