CD-CLLCT Customer Service Representative (CSR)
2F Ramos Bldg., Arellano St., Tagum City, Davao del Norte
5F Robinsons Cybergate Delta, Tower 2, J. P. Laurel Ave., Bajada, Davao City, Davao del Sur
Full Time
Position Overview
The CD-CLLCT Customer Service Representative (CSR) is responsible for managing a wide range of customer interactions, including claims processing, insurance verification, payment posting, and accounts reconciliation. The role involves ensuring the accuracy of patient information, managing insurance claims, posting payments, and reconciling accounts while adhering to the company’s performance and quality standards. The CSR plays a critical role in maintaining client satisfaction and supporting the overall objectives of the CD-CLLCT team.
Supervisory: No
Duties and Responsibilities
Key Responsibilities:
Claims Processing and Management:
Ensure that claims are filed, verified, and refiled as needed.
Upload Explanation of Benefits (EOBs) and verify claim status through Coastnet and insurance company websites.
Contact insurance companies to verify claim status and provide additional documents as required.
Update and close claims on Coastnet, ensuring accuracy and completeness.
Insurance Verification:
Prioritize and check appointments scheduled within 24-72 hours.
Verify patient insurance details and fee schedules by contacting insurance companies or using their websites.
Update patient information in Coastnet and ensure that the fee schedule is properly linked.
Message patients via NextHealth for updated insurance plans if coverage has expired.
Payment Posting:
Check assigned MCNA EOBs on the insurance company's website to determine which offices and patients the payments are for.
Post payment amounts on Eaglesoft and process adjustments for claims not fully paid.
Refile claims for procedures with incorrect codes and process walkouts on Eaglesoft as necessary.
Run reconciliation reports and submit them to the Collections Manager.
Performance Management:
Meet or exceed performance targets such as handling times, quality scores, and customer satisfaction ratings.
Participate in regular coaching sessions to improve performance and address areas for development.
Accounts Reconciliation:
Reconcile information between the Corporate Deposit window and Eaglesoft, ensuring that details match.
Investigate and resolve mismatches by creating an "Issue" and following up with the office for resolution.
Escalate unresolved issues to the Office Manager and client as necessary.
Quality and Process Adherence:
Adhere to established quality standards, company policies, and client requirements.
Participate in internal and external huddles to address and raise issues and concerns.
Meet assigned daily quotas within designated timeframes and ensure tasks are completed accurately.
Collaboration and Communication:
Work closely with team members and supervisors to ensure seamless workflow and problem resolution.
Provide clear and timely updates to relevant stakeholders regarding claim status, payments, and reconciliation issues.
Continuous Improvement:
Actively contribute to process improvement initiatives and share insights from daily tasks to enhance overall efficiency.
Stay updated on industry best practices and integrate them into daily activities.
Other Duties:
Perform any other duties assigned by the Team Leader or Supervisor from time to time.
Reports to
Team Leader
Qualifications and Characteristics
Qualifications:
Education: College-level education in a business-related course or a field relevant to healthcare industry practices.
Experience: At least six (6) months of experience in a BPO company in a similar capacity. Preference for those with healthcare industry experience.
Skills:
Proficiency in computer use and data entry.
Skilled in navigating and using various computer applications, including CRM software, with accuracy in data entry.
Effective written and spoken English with strong communication skills.
Demonstrated ability to convey information clearly and professionally in both written and verbal forms.
Ability to handle multiple tasks and manage time efficiently.
Capable of managing several tasks simultaneously while maintaining high standards of service and meeting deadlines.
Strong problem-solving skills and attention to detail.
Ability to quickly identify issues, troubleshoot effectively, and ensure thorough, accurate documentation and resolution.
Shift and Location: Willingness to work in a graveyard shift and be stationed in the Davao Region.
Key Competencies:
Analytical Thinking:
Strong ability to analyze data and financial information to identify discrepancies and resolve issues.
Attention to Detail:
Ensures accuracy in processing payments, posting, and managing accounts reconciliation.
Customer-Focused:
Ability to handle customer inquiries regarding collections with professionalism and empathy.
Time Management:
Manages multiple tasks efficiently, such as handling inbound and outbound collections calls, verifying insurance details, and posting payments.
Integrity and Compliance:
Adheres strictly to regulatory and company policies related to collections, insurance verification, and payment posting.
Preferred Personality Type
The individuals best suited for this role are those who are:
Conventional: Adhere to established procedures and guidelines.
Competitive: Driven to meet and exceed performance targets.
Assertive: Confident in communication and capable of managing challenging interactions.
Motivated: Self-driven with a strong work ethic and a commitment to continuous improvement.
Patient: Able to remain calm and composed under pressure, particularly in high-stress situations.
This Job Description outlines the primary responsibilities and qualifications required for the role of CD-CLLCT Customer Service Representative. It is not exhaustive and may be subject to change based on the needs of the company.
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