Communicate vision benefit plan information to members and p rovide authorizations to providers.
Locate and understand CompuVision screens relating to job function (including Order Entry screen and Eligibility screen).
Access the Interactive Voice Response unit (IVR) to assist with member inquiries.
Understand steps taken when member is not on file know how to create and follow-up with eligibility record.
Understand and relay information regarding split benefits including reading the plan fields to determine patient specific eligibility.
Process/file update student proof requirements, enrollment cards, disabled children forms, deletion forms, returned vouchers, special vouchers & provider list pulls.
Issue vouchers to members requiring paper. Explain benefit information, update address file, issue PPL, SPD and other member documentation through CompuVision or label system (i.e., PPL, Lens 123, SPD).
Issue authorizations for split and non-split groups. Place calls to providers to explain benefit design.
Authorize special services involving overriding member records and placing calls to provider and lab.
Create record of out-of-network stop payment inquiry requests, logged concerns/requests, complements, and NPP requests.
Relay information regarding purchase programs and create purchase requests on CompuVision.
In-depth understanding of benefit groups.
Locate internal documentation and member/group specific documentation.
Relay information on the LENS 1-2-3 benefit.
Relay information on differences between copay/out-of-network expense, non-plan allowance/retail values, and indemnity/out-of-network.
Understand provider status: Profile, Cole Vision locations, optical establishments, assignment, prospect, and kitless. This involves different fee schedules
Knowledge of specialty services and forms (prior approval, medically necessary contacts, and referrals to an MD).
Mentor perspective associates and new associates during initial instruction. This involves providing feedback to the EQA Team.
Knowledge of where and when to transfer calls within Latham and Plainview.
Interact with Network Providers when handling challenges..
Understanding of lens styles, materials and frame styles.
Issue deletion letters, extension cards, and duplicate vouchers.
Understand out-of-network process and proper information; i.e.: claim submission instructions, fee information, and processing time. Includes explanation of the MOB rule.
Accept inquiries from various benefit groups requesting assistance (Benefit information, eligibility, challenges, and claims submission information).
Explain or direct members with hearing and medical/surgical coverage questions. This includes doctor participation and payment schedule.
Access group specific on-line eligibility system.
Adhere to privacy and confidential and proprietary company policies and procedures (i.e. HIPAA).
Participate in any/all training and educational activities necessary to fulfill at least the minimum requirements as specified within your departmental goals. This is in addition to, the completion of any activities necessary for the maintenance of professional affiliations or organizational requirements.
Diligently maintain the cleanliness of all equipment, workstations and the overall facility on a daily basis.
As required by changing business needs, complete additional responsibilities as assigned.
High School diploma or equivalent.
Experience & Background:
· Customer Service experience preferred.
· Computer experience helpful.
· Bilinguality advantageous.
· Insurance experience helpful.
· Minimum 1-year experience in professional office environment.
Keyboard skills preferred