Customer Ser Prof CSP Level I

Position Summary

Customer Service Professionals (CSP’s) on the Electronic team are responsible for supporting client retention and PT referral objectives by consistently handling new EOC/case requests from all sources including Adjuster, NCM, Payer, TPA, Doctor, Employer, Provider (Center) and Patients. The new EOC/case opening are all conducted electronically meaning by Email, Fax, Adjuster Portal, MM package receipt and EDI process. Productivity and quality of work are of equal importance.

Primary Duties & Responsibilities

• Receive inbound electronic referrals from Adjusters, NCMs, Centers, MDs, patients etc.
• Open new EOCs/cases accurately according to policy and procedures.
• Review case information to determine if a new case needs to be opened or patient can be followed in existing case.
• Make first outbound attempts with various sources to verify new case/missing information, requesting Verification from Insurance Carriers or request other related paperwork telephonically
• Maintain productivity and quality EOC monitoring goals daily/monthly.
• Validate new case data by reviewing, correcting, deleting, or re-entering data; combining data when account information is incomplete.
• Phone trained CSPs with prior MedRisk Inbound call center experience will be called upon to assist with incoming calls during a time of crisis.
• Forward any email/fax to proper dept. Attachment documents appropriately to new/existing EOCs.
• Understand MedRisk’s interdepartmental procedures, policies and comply with them.
• Identify potential or existing system and/or procedural challenges, and notify Supervisor and assist in resolution if needed.
• Complete special projects or tasks as assigned by the supervisor.
• Compliance with HIPPA and URAC guidelines
• Other duties as assigned.

Qualifications

• Bachelor’s Degree preferred or industry experience equivalent
• Excellent verbal and written customer service skills demonstrating a can-do attitude.
• Highly developed problem-solving skills.
• Strong data entry skills
• Detail oriented and solid organizational skills
• Solid MS Word, Excel and Outlook experience
• Must have ability to multi-task and work independently