Customer Service Rep III - PHC

Peer Mentor Responsibilities

This employee is a peer mentor for the department, responsible for setting a professional example in business acumen. This employee must accurately, thoroughly, and in a time-sensitive manner process patient orders and provide clear and timely communication to all stakeholders.

1. Proficient in and performs all Customer Service I and II core responsibilities
2. Respond to telephone inquiries and orders from patients and referral sources
3. May assist walk-in patients with the selection of equipment, supplies, and services
4. Determine resolution of patient and referral inquiries, questions, or concerns
   • Identify concerns and ensure they are recorded in Concern Tracker system when appropriate
5. Complete electronic intake process in billing system, perform verification of insurance, and review all documentation for accuracy to qualify patient for services
6. Contact patients to inform them of any patient payment requirements, collect payment, and determine best delivery method to provide instructions for receiving delivery
7. Understand and abide by Accreditation Commission for Health Care (ACHC) requirements
8. May need to understand and interpret Medicare guidelines and qualifying documentation
9. Thoroughly understand payer and utilization guidelines
10. May process insurance authorization and follow up on requests as needed
11. Establish positive relationships with referral sources and build rapport with internal and external customers
12. May be required to perform quality assurance process, confirming accuracy of orders prior to submission for reimbursement
13. Understand C-PAP compliance guidelines as required by assignment or has obtained knowledge of rehab specialty equipment and coverage criteria
14. Consistently meet Quality Assurance score of 85% or above
15. Provide coverage in all areas of assigned department as needed
16. Set the working example for other Patient Service employees in business acumen and knowledge
17. Complete departmental projects as assigned
18. Peer to peer coaching as needed