MBS Customer Service Representative, Level 1 Job Description

Summary: The MBS Customer Service Representative, Level 1 will work as part of a team to ensure that the quality of customer service provided to our customers meets or exceeds the highest standards for the organization. This includes measurements of accuracy of information provided, consistency in documentation of each request, and will assure that appropriate general, claim, and grievance inquiry codes are documented. The MBS CSR will service and resolve the customer inquiries related to claims, eligibility, and benefit plans administered by MBS.

Specific Duties and Responsibilities: Provide service and resolution when applicable at the levels defined for entry level customer service

representative. Log each inquiry into the database and document the call type, referral code and all narrative documentation to support the call. If necessary determine the need for resolution within the appropriate referral channels and send request for additional action steps. Make necessary outbound calls to correct issues or facilitate resolution for customer.

Stay abreast of resource information to ensure appropriate information is being provided. This includes, but is not limited to training manual, plan documents, on-line reference tables, claims system, client benefit summaries (CBS) and schedules of benefits.

Coordinate resolution of open issues from incoming calls assigned either through management of open issues log, or through call backs requested from voice mail.

Participate in weekly staff meetings and monthly training meetings related to skill enhancement and informational purposes.

Effective queue management based on defined adherence goals, and/or staffing issues necessitating awareness.

Additional duties as assigned

Minimum Job Requirements:

High school diploma or equivalent required; Advanced degree or certification preferred

Knowledge and/or experience with medical terminology, CPT-4 coding, ICD-9 and ICD-10 coding preferred

Creative thinking and effective problem solving skills are necessities

Typing skills of 30-35 words per minute

Excellent communication skills, with customer service experience required

Knowledge of the health care industry, call center queue environment, and claims payment processes preferred

Access to Protected Health Information This position will require the employee to handle Protected Health Information (PHI) for duties related to provider credentialing, complaints and grievances, claims issues, health management issues, and risk and compliance issues. Access to the PHI contained in the Claims, Health Management, and Provider Credentialing systems is necessary for this staff member.

Privacy and Security Responsibilities Responsible and accountable for maintaining the confidentiality, integrity, and availability of protected health information. Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach. MedCost, LLC Health and Welfare Plan Access to PHI An employee in this position may be designated to handle all customer contact calls by or for the plan participant/member.