Participant Services Rep - Insurance Coverage and Order Representative - NTT DATA
Wilkes, PA
About the Job
Participant Service Representative - Pharmacy Orders and Insurance Coverage
Location: On Site - 1 Great Valley Blvd., Wilkes-Barre, PA 18706Must be 50 miles between the residence and the report to location. There will be onsite days during the week and travel to the office is necessary.
Hours:Monday - Friday 9:00 am 5:00 pm
Position Summary:
As a Participant Services Representative you will be involved with extensive member contact via the telephone. Handles inbound/outbound calls from participants and/or prescribers when needed to start and process order requests. Ability to research and investigate orders using PeopleSafe and LINKS. Research issues sent by Customer Care, Account Managers, internal customers and Quality Assurance relative to the customer service experience. Notifying requestor of decisions, changes, or other relevant information pertaining to request/inquiry. Follow through on standard operating procedures, problem-solving and troubleshooting within guidelines. Ability to work under strict turn-around-times.
You will be verifying insurance coverage for potential new clients. Additionally, this person will re-verify insurance coverage for existing patients in order to process patient prescription needs successfully and demonstrate excellent customer services to patients, healthcare professionals, and insurance carriers. This role will require an understanding of insurance concepts, including drug cards, major medical benefits, and per diem coverage, as well as knowledge of government and patient assistance programs. Strong attention to detail, and proven analytic and problem solving.
Duties:* Effective delivery of company health coverage products and services (40%)* Responds to telephone inquiries and orders from homecare patients and referral sources.* Provides information on equipment, supplies and services. Determines the best method for providing services.* May assist walk-in patients with the selection of equipment, supplies and services. Timely processing/facilitation of patient orders (30%)* Processes telephone orders by preparing patient paperwork.* Verifies insurance and/or other method of payment.* Completes all necessary paperwork in an accurate and efficient manner to facilitate the data entry, accounts receivable and delivery of the order placed.* May perform data entry.* Distributes copies of paperwork to appropriate personnel.* May assist with the processing of billing paperwork. Effective coordination of patient services/supplies (10%)*Coordinates the delivery, set-up and pick-up of equipment, supplies and services with appropriate personnel.* Ensures deliveries and set-ups can be arranged in a timely manner. Appropriate documentation (10%)* Accurately maintains files of all patient account profile information and referral source data. Customer satisfaction (10%)* Resolves patient complaints by identifying problems and coordinating appropriate corrective action.
Minimum Job Qualifications:* Minimum of 1 year in a customer service or call center environment (call center type environments preferred, if doctors office then anything below managing 75 calls/day would not translate to similar environment).* 1 year of experience using Microsoft Outlook, Word and Excel in a work setting.
Preferred Job Requirements:* 6 months knowledge of Medicare, Medicaid, and health insurance.* Experience in a health care setting or insurance industry is a plus, including knowledge of basic insurance and third party terms and medical terminology.* Effective and empathetic communication style in managing inbound calls and communications with clients and team members.* Basic alpha number data entry skills with attention to accuracy and quality is essential.* Intermediate math skills are required with attention to detail and quality essential.* Ability to work with people in a team environment while meeting individual performance goals.* Must be able to read and interpret policies, procedures and instructions.* Effective organizational skills and ability to prioritize a fluctuating workload and competing priorities is essential.
Education:Verifiable High School diploma or GED is required.
About NTT Data Services:
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.
NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.
Location: On Site - 1 Great Valley Blvd., Wilkes-Barre, PA 18706Must be 50 miles between the residence and the report to location. There will be onsite days during the week and travel to the office is necessary.
Hours:Monday - Friday 9:00 am 5:00 pm
Position Summary:
As a Participant Services Representative you will be involved with extensive member contact via the telephone. Handles inbound/outbound calls from participants and/or prescribers when needed to start and process order requests. Ability to research and investigate orders using PeopleSafe and LINKS. Research issues sent by Customer Care, Account Managers, internal customers and Quality Assurance relative to the customer service experience. Notifying requestor of decisions, changes, or other relevant information pertaining to request/inquiry. Follow through on standard operating procedures, problem-solving and troubleshooting within guidelines. Ability to work under strict turn-around-times.
You will be verifying insurance coverage for potential new clients. Additionally, this person will re-verify insurance coverage for existing patients in order to process patient prescription needs successfully and demonstrate excellent customer services to patients, healthcare professionals, and insurance carriers. This role will require an understanding of insurance concepts, including drug cards, major medical benefits, and per diem coverage, as well as knowledge of government and patient assistance programs. Strong attention to detail, and proven analytic and problem solving.
Duties:* Effective delivery of company health coverage products and services (40%)* Responds to telephone inquiries and orders from homecare patients and referral sources.* Provides information on equipment, supplies and services. Determines the best method for providing services.* May assist walk-in patients with the selection of equipment, supplies and services. Timely processing/facilitation of patient orders (30%)* Processes telephone orders by preparing patient paperwork.* Verifies insurance and/or other method of payment.* Completes all necessary paperwork in an accurate and efficient manner to facilitate the data entry, accounts receivable and delivery of the order placed.* May perform data entry.* Distributes copies of paperwork to appropriate personnel.* May assist with the processing of billing paperwork. Effective coordination of patient services/supplies (10%)*Coordinates the delivery, set-up and pick-up of equipment, supplies and services with appropriate personnel.* Ensures deliveries and set-ups can be arranged in a timely manner. Appropriate documentation (10%)* Accurately maintains files of all patient account profile information and referral source data. Customer satisfaction (10%)* Resolves patient complaints by identifying problems and coordinating appropriate corrective action.
Minimum Job Qualifications:* Minimum of 1 year in a customer service or call center environment (call center type environments preferred, if doctors office then anything below managing 75 calls/day would not translate to similar environment).* 1 year of experience using Microsoft Outlook, Word and Excel in a work setting.
Preferred Job Requirements:* 6 months knowledge of Medicare, Medicaid, and health insurance.* Experience in a health care setting or insurance industry is a plus, including knowledge of basic insurance and third party terms and medical terminology.* Effective and empathetic communication style in managing inbound calls and communications with clients and team members.* Basic alpha number data entry skills with attention to accuracy and quality is essential.* Intermediate math skills are required with attention to detail and quality essential.* Ability to work with people in a team environment while meeting individual performance goals.* Must be able to read and interpret policies, procedures and instructions.* Effective organizational skills and ability to prioritize a fluctuating workload and competing priorities is essential.
Education:Verifiable High School diploma or GED is required.
About NTT Data Services:
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.
NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.
Source : NTT DATA
