Under the general direction of the Customer Team Lead, the Customer Service Representative's primary function is the timely processing of referral orders for durable medical equipment that are received primarily via phone, Epic or fax. The scope of responsibility of this position includes acting as a resource for MAC staff and referral sources as well as performing patient intake, order entry, insurance authorization and medical documentation processes. Regulatory compliance to optimize the organization's revenue cycle is vital to the organization's success. Customer satisfaction is critical and this position requires eye to detail, organization, and a focus on the big picture for Mercy Assisted Care. The incumbent will follow appropriate policies and procedures and maintain a thorough knowledge of the various aspects of the DME industry. This position follows the mission and vision of the Mercyhealth.
Responsibilities
Essential Duties and Responsibilities
- Manages phone calls from patients and referral sources.
- Responsible for intake of referral orders from phone calls, Epic and faxes, using departmental procedures.
- Performs insurance verification on each order to assess coverage, documentation and prior authorization needs.
- Obtains and reviews clinic notes, progress notes, orders, demographics, face-to-face and medical justification documentation from referrals to meet documentation expectations for Mercy Assisted Care per Federal, State and payer requirements.
- Maintains current knowledge of relevant documentation requirements for products provided by Mercy Assisted Care.
- Processes and submits prior authorizations for insurance approval of equipment rental or purchase.
- Responsible for entering accurate work order information, selecting appropriate supplies and/or equipment and delivery method for a seamless delivery. Maintains assigned Operator Tasks to ensure timely follow up with tasks.
- Schedules repairs for on-site repair technician.
- Reviews and obtains valid prescriptions through the Rx workflow.
- Reviews, routes and processes faxes through the fax workflow.
- Problem solves a wide range of customer issues and complaints, appropriately referring issues outside their scope of practice.
- Works with MAC purchasing department to subcontract orders from outside vendors for Mercy system patients.
- Must be able to select appropriate products given patient's medical need, life style and overall condition. Familiar with contraindication of all products and liability issues for MAC.
- Acts as liaison between Mercy Assisted Care and key internal and external customers/ referral sources.
- Responsible for maintaining and working the auto reorder program for supplies
- Maintain up-to-date, accurate information regarding equipment to meet accreditation and regulatory requirements.
- Verify patient's demographic/insurance (payer) information to ensure accurate input to billing for reimbursement.
- Monitor reports for timely renewals of prescriptions, prior authorizations, rentals and missing information.
- Responsible for absorbing and applying information provided in Customer Service Huddles, Customer Service meetings and MAC all staff meetings.
Culture of Excellence Behavior Expectations
To perform the job successfully, an individual should demonstrate the following behavior expectations:
Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.
Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.
Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.
Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.
Education and Experience
High school diploma or equivalent; or 1 year's related experience and/or training; or equivalent combination of education and experience.
Certification and Licensure
N/A
Skills and Abilities
N/A
Special Physical Demands
The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. Must be able to read and write in English. The employee must occasionally lift and/or move up to 10 pounds. These Special Physical Demands are considered Essential Job Functions of the position with or without accommodations.
Level of Supervision
N/A
Supervises
N/A