Job Title:   (Temporary Medical) Customer Service Representative
Pay Grade:   3
Pay Band Min / Max:    - 
 
Position Number:   046396
Department / Hospital:   UMBH

The University of Miami Miller School of Medicine-UHealth is home to some of the brightest minds in the world. Our Faculty teach students who represent the future of medicine. Our researchers are discovering breakthrough patient treatments. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and subspecialties, and have more than one million patient encounters each year.
 


The University of Miami Behavioral Health is seeking a Temporary Customer Service Representative. Responsible for maintaining/updating the IDX Managed Care Application (MCA) based on provider forms/documentation (data entry of member specific information into IDX based on provider submission of Initial Outpatient Clinical Review, Outpatient Continued Care Assessment, Child & Adolescent Assessment Checklist Forms, Medicaid Quarterly Clinical Review Form-CMHC, CFARS/FARS); verify member specific eligibility through Medifax; enter, review, communicate, and coordinate Provider Termination/Transition Requests in order to maintain member continuality; review, update, and coordinate monthly and quarterly Change of Provider Reports in IDX; enter, track, communicate and coordinate Single Case Requests; data enter Provider Discharge Summary reports into IDX Treatment Outcomes Reports.

Access and transfer calls to appropriate care management team (Assessment & Referral, Acute Care, and Targeted Care Management). Review and explain to members, providers and facilities Mental Health & Substance Abuse benefit information. Assist in the coordination of continuous quality improvement activities for the UMBH Member Service department. This position will serve as primary back-up with indexing and verification of member specific information into IDX. As back up support, this position will also be responsible for adhering to the Member Service Department telephone standard goals (abandonment rate of <5% and the answer speed of 30 seconds or less); adhering to the standards set forth for practitioner requests of authorization and timely turnaround.


High School Diploma or equivalent and one year of member service experience in a behavioral health care setting with advanced KSA’s and experience within health care or behavioral health care insurance s required. Ability to be responsible and independently to coordinate the day to day activities of member services representative in the absence or unavailability of the supervisor as needed. Assist in the orientation and training of new member services employees and ongoing continuous quality improvement activities for all member service employees.

Must have advanced computer navigational skills and the ability to work in a high volume work environment, provide effective and efficient customer service to members and providers, maintain confidentiality, and maintain high levels of customer service satisfaction. Excellent communication and interpersonal skills required. Any appropriate combination of education, certifications, and/or relevant experience will be considered.


UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the groundbreaking research and medical education at the Miller School of Medicine. University of Miami Hospital is the flagship facility of UHealth, which also includes the Sylvester Comprehensive Cancer Center and Bascom Palmer Eye Institute, along with dozens of outpatient facilities. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer - Female/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.



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The University of Miami is an equal opportunity/affirmative action employer.