Position Summary
As a Customer Advocate, you will be supporting communication between MedRisk/SPNet's network providers and referring adjusters and nurse case managers. You will report to the Customer Advocate Team Lead and/or Supervisor to help strengthen MedRisk/SPNet's referral process, ensuring efficient workflow, while increasing customer satisfaction. Acting as liaison, the Customer Advocate tracks patient progress from the start of treatment, throughout treatment, and through to closure by obtaining relevant case updates from providers, including but not limited to dates of service, compliance, treatment notes, and continued authorization. They are responsible for maintaining the integrity of the case file and related documents and communicating professionally and effectively with the customer.
Primary Duties & Responsibilities
Level I:
- Manage claims and monitor case status by confirming patient attendance with network providers, and addressing any concerns regarding compliance
- Properly update all case related data to MedRisk's database/platform
- Track and relay authorization to our providers as directed by the clients with confirmations to the adjuster and NCM
- Be knowledgeable regarding the client's unique needs and respond appropriately
- Build approachable, professional relationships with providers and referring customers.
- Compliance with HIPAA and URAC guidelines
- Employee is expected to work a minimum of 60 tasks daily
Level II: In addition to the Level I duties and responsibilities-
- Assist with training/shadowing new hires and provide constructive feedback on their progress
- Identify additional areas of support post training
- Provide proper support within system navigation
- Assist with escalated and time sensitive client and customer requests
- Complete special projects as assigned
- Provide coaching opportunities for peers to Team Leads and Supervisors as identified
Level III: In addition to the Level I & Level II duties and responsibilities-
- Be a subject matter expert in workflows/processes
- Provide coaching opportunities for peers to Team Leads and Supervisors, as identified
- Actively participate in assisting Trainers on workshops and training the team
- Become valued contributors within the Senior Mentor Program
- Build strategies for more efficient workflows within our systems
Qualifications
- Bachelor's Degree preferred; impeccable customer service skills with 2-3 years of experience preferred
- Healthcare experience required; minimum of 1 year preferred
- Experience working with a US company (PH specific)
- Ability to work independently and multi task in a fast paced environment
- Detail oriented
- Excellent verbal & written communication skills
- Basic knowledge of Microsoft Word, Excel, Outlook and Zoom
- Computer skills in Windows environment
- Time management and strong organizational skills
- Adaptability
- Ability to receive constructive feedback
- Strong work ethic
- Competencies (choose at least 4)
- Customer Focus
- Comprehensive Computer Skills
- Listening
- Informing
- Action Oriented
- Ethics and Values
- Priority Setting
- Integrity and Trust
Working Conditions & Physical Requirements
- Office & Home environment
- While mostly sedentary, the job includes walking, standing, sitting, possible twisting, kneeling
- Visual acuity (color, depth perception and field of vision)
- Substantial movements (motions) of the arms, wrists, hands, and/or fingers
- This position requires consistent communication both verbally and electronically. Candidate must be able to utilize exceptional verbal and written communication skills.
