Job Description

We are looking for a Customer Service Representative to join our Member Services team in West Hills, CA .

Under general supervision, respond to telephone inquiries from members, Health Plans, providers and employer groups to provide information and clarification relating to RMG services such as claims, referrals, and eligibility in resolving inquiries and more:

Essential Duties and Responsibilities include the following:

• Serve as the primary point of contact for members, addressing inquiries related to authorizations, billing, eligibility and general information, and services in both English and Spanish.
• This position is accountable for providing quality customer service handling incoming/ outgoing calls involving issues from members, providers and health plans.
• Maintain or exceed quality and productivity standards of 35 calls per day with clear and concise detailed documentation of 90% incidents
• Research and resolve routine or complex issues relating to services provided by RMG/LMG/ADOC. This includes eligibility, referral status, provider availability, case management, utilization management, billing related issues and general information.
• Ability to work independently in the resolution of member complaints and other service related issues.
• Resolve issues and concerns efficiently by coordinating with relevant departments and maintaining accurate records of member interactions.
• Educate members on their rights and responsibilities, as well as the proper use of health care
• Maintain up-to-date knowledge of HMO policies, procedures, and health care regulations to provide accurate information.
• Facilitate communication between members and healthcare providers to ensure clarity and
• Participate in training sessions and team meetings to enhance service delivery and share best practices.
• Contribute to a positive and supportive team environment.
• Prioritize assignments and other work functions in order to maintain workflow.
• Display professionalism, good judgment, maturity, and fairness when interacting with others.
• Perform copy and fax functions as needed.
• Maintain accurate and good grammatical communication, both verbal and written, with all levels of management, staff, members and providers.
• Follow HIPAA guidelines with all information pertaining to member medical information and privacy
• Display warm and pleasant phone personality, emphasizing tact, empathy and patience.
• Other duties as assigned.

The pay range for this position at commencement of employment is expected to be $21 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Qualifications

Education and/or Experience:

• Minimum two (2) years of customer service and public relations experience in a medical setting
• High School Diploma or equivalent is required
• Ability to deal responsibly with matters of a confidential nature.
• Ability to multi-task and meet deadlines in a high stress environment
• Must have excellent communication skills, both verbal and written.
• Ability to read, write and understand the English language.
• Pleasant telephone manner as well as telephone etiquette
• The ability to distinguish the differences between CPT, HCPCS, Revenue, and ICD coding.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
• Knowledge of computers, faxes, printers and all other office equipment.
• Self-starter, willing to take on multiple tasks.
• Must be able to review and interpret health plan benefits and provider contracts.
• Able to interface with customers both internal and external of RMG.
• Typing 45 WPM with accuracy.
• Ability to communicate effectively orally and written answering and resolving a minimum of 65 calls per day with matching documentation.
• Strong organizational skills with emphasis on prioritizing and attention to details.
• Managed Care experience is a plus