Medical Customer Service Specialist

Department: Customer Service
Location: Winston-Salem, NC

Application Instructions

Please email your resume in .doc, .docx, .pdf, .txt, .rtf, .html, or .ascii format to the address below. If you wish to enclose a cover letter, please include it in the body of your email message.

Job Summary

Answer & conduct phone calls in a timely, professional, and courteous manner and according to applicable compliance procedures and client specifications.

Major Responsibilities/Activities

• Answer phone calls quickly and in a pleasant, professional manner
• Identify each caller’s needs and determine the next appropriate action, which may include clarifying charges/payments, collecting, adding, updating, and filing insurance, resolving complaints, and/or notifying supervisors/management of complaints that cannot be resolved on the first call
• Address each caller’s needs while being sensitive to the appropriate amount of time needed to complete and close the call in a courteous and professional manner
• Accurately document each call and the outcome in the Sanitas system in an efficient, clear, and concise manner. Documentation must be understandable if read at a later date and/or by another employee
• Identify appropriate situations for transferring/escalating a call to a senior advisor, supervisor or member of management
• Detect caller patterns and provide appropriate feedback to supervisor in order to reduce or prevent possible future calls
• Conduct all job tasks, duties, phone calls, and interactions with professionalism, respect, a positive attitude, and in accordance with company compliance policies and applicable government regulations
• Consistently support and demonstrate the company mission and values

• Perform administrative or billing-related tasks as directed
• Assist with special projects as directed
• Participation in relevant meetings or events
• Perform other necessary tasks as assigned by supervisor

• Completion of new hire billing training with at least 90% QA maintained
• Employee must learn to handle all types of calls/callers and still remain calm & professional while addressing the caller’s need in a timely manner
• Employees must maintain an acceptable production rate.
• Return all calls and follow up on all outstanding issues within 24 business hours
• Employeesare expected to successfully complete CS training and verify own work within 90 days of entering the CS Department.
• Employee must be in this role for at least 60 days before moving into CS Specialist I role. Rare exceptions may be made for internal hires, based on performance.

Required Education, Skills, & Experience

• High School diploma
• At least 1 year experience in a customer service role within a clerical/administrative environment
• Excellent customer service skills & telephone etiquette
• Strong & professional verbal, written, and telephone communication skills; this is normally acquired via one to three years of office experience.
• Working knowledge of Microsoft Office programs
• Dependable and reliable work attendance to ensure phone coverage
• Ability to function well within a cross-functional team setting and independently
• Ability to work independently with minimal supervision
• Resourceful
• Must possess critical thinking/analytical skills
• Highly organized with ability to manage time and prioritize work well
• Must be able to handle disgruntled callers professionally, effectively, and with tact
• Strong data entry skills

• Strong preference for demonstrated understanding of Medicare, Medicaid, insurance, liability, tertiary payment methods, and HIPAA regulations
• Prior experience with medical billing or terminology either in an employment role or classroom setting
• Prior experience providing customer service in a production environment.
• Proficient in Sanitas software