Randstad USA Hiring for Healthcare Customer Service Associate at Boston, MA Full Time

Prior Authorization Services Associate (Inbound/Outbound)

100% Remote

Start day: 2/12

$17.00 per hour

Training 4 weeks – 8-5

***Seeking candidate with prior authorization experience in healthcare.

This position is part of an operations team that strives to provide first call resolution to a specified set of customers. This position primarily answers incoming calls for new and existing authorizations. Responsibilities include documenting in the appropriate systems and ensuring high quality and accurate information is provided to callers. This role is expected to meet or exceed operations production and quality measures.

• Understand the end-to-end authorization process, and the business drivers for success.
• Actively listen and probe callers in a professional and timely manner to process authorizations and/or other customer service requests working towards first call resolution.
• Research and communicate information regarding member eligibility, provider status and authorization inquiries to callers while maintaining confidentiality.
• Resolve customer complaints or concerns as the first line of contact.
• Make problem resolution and triage decisions not requiring clinical judgment.
• Discourage unnecessary clinical/physician phone transfers and encourage medical records to be submitted. Help callers understand what clinical information is required.
• Transfer calls to clinicians and physicians only for clinically escalated situations.
• Communicate appeal and denial language to providers and members when appropriate.
• Process withdrawals and other case status changes as needed.
• Understand client and regulatory expectations for accounts in their designated region.
• Recognize and develop relationships with provider groups through repeat calls and provider sensitivities for different health plans.
• Is responsible for reading and retaining information disseminated through multiple resources, ensuring calls are handled accurately and appropriately per current account information.
• Process fax attachments in between calls.
• Responsible for meeting Service standards in all categories monthly, be a team player, always maintain member and provider confidentiality, demonstrate effective problem-solving skills, be punctual, and maintain good attendance.
• Participate in Service Operations activities as requested that help improve Care Center performance, excellence, and culture.
• Support team members and participate in team activities to help build a high-performance team.
• Demonstrate flexibility in areas such as job duties and schedule to aid Customer Care Operations in better serving its members and help achieve its business and operational goals.
• Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Assume responsibility for self-development and career progression.

HSD or equivalent required.

Preferred Experience We Look For:

• Prior Customer Service experience.
• Must be a proficient typist (at least 30 WPM) with the ability to maneuver through various computer platforms/screens while verifying a variety of information simultaneously.
• Ability to multi-task while staying organized.