Healthcare Customer Service Advocate | Prior-Authorization | WFH

Position Summary

The Customer Service Advocate – Utilization Management is a vital member of our healthcare team, playing a key role in managing calls related to authorizations for various healthcare services. In this role, you will be responsible for ensuring that provider offices and health plans receive timely and accurate information regarding patient authorizations.

This position requires experience in the US healthcare system, specifically within utilization management or case management, with a strong preference for experience working on the provider side.

Key Responsibilities

Handle Inbound Calls:

• Receive and respond to calls primarily from provider offices and occasionally from other health plans.
• Provide information on the status of authorization requests, including both inpatient and outpatient services
  
  

Authorization Management

• Address and manage re-direct requests for outpatient services.
• Handle requests to re-fax authorization documents as needed.
  
  

Lines Of Business

• Manage calls related to Medicare, Exchange, and Plan-to-Plan authorizations.
  
  

Documentation And Compliance

• Accurately document call interactions and outcomes in the appropriate systems.
• Ensure compliance with all relevant regulations and guidelines.
  
  

Customer Service

• Maintain a high level of professionalism and customer service in all interactions.
• Resolve issues promptly and effectively, ensuring customer satisfaction.
  
  

Education, Experience And Skillset

• Excellent analytical, organizational, and time management skills
• Strong multi-tasking skills and able to adapt to changing expectations and priorities
• Able to exercise a high level of tact and discretion in both internal and external interactions
• Strong written and verbal communication and interpersonal skills
• Proficient in all MS-Office Applications and use of the Internet
• Key attention to detail and accuracy
• Ability to work closely with other employees with patience and flexibility to take on new tasks
  
  

Requirements

• Open to SHS or College Undergraduates (2nd Year).
• Call Center/BPO Experience is a must.
• At least 2 years of BPO Healthcare exp (Voice) - UM/Utility Management with Provider voice interaction.
• In-depth knowledge of Medicare, Exchange, and Plan-to-Plan authorizations.
• Knowledgeable in Healthcare terminologies.
• Willing to work on shifting schedules, graveyard shift, holidays and weekends if required.
• Candidate residing in Manila or nearby provinces is preferred.
• Stable internet connection not less than 35mbps.
• Dedicated workspace suitable for remote work.
  
  

Additional Benefits

• Flexible work arrangement - Work-from-home
• Equipment is provided
• Transportation Allowance
• Medical Allowance
• HMO (medical and dental coverage)
  
  

Company Overview

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, FL, USA operates 10 regional offices throughout the U.S. and has a wholly-owned global delivery center in Manilla Philippines.

• Other Requirements:
• Can start immediately. This is an urgent hiring need!
• Candidate residing in Manila or nearby provinces is preferred.