Customer Service Rep, Mercyhealth Mall

• Janesville, Wisconsin
• Status: Full-Time Benefits Eligible
• Schedule: 40 hours/week, Monday-Friday, 9:30am-6:00pm

Under the general direction of the Customer Team Lead, the Customer Service Representative's primary function is the timely processing of referral orders for durable medical equipment that are received primarily via phone, Epic or fax. The scope of responsibility of this position includes acting as a resource for MAC staff and referral sources as well as performing patient intake, order entry, insurance authorization and medical documentation processes. Regulatory compliance to optimize the organization's revenue cycle is vital to the organization's success. Customer satisfaction is critical and this position requires eye to detail, organization, and a focus on the big picture for Mercy Assisted Care. The incumbent will follow appropriate policies and procedures and maintain a thorough knowledge of the various aspects of the DME industry. This position follows the mission and vision of the Mercyhealth.

Essential Duties and Responsibilities

• Manages phone calls from patients and referral sources.
• Responsible for intake of referral orders from phone calls, Epic and faxes, using departmental procedures.
• Performs insurance verification on each order to assess coverage, documentation and prior authorization needs.
• Obtains and reviews clinic notes, progress notes, orders, demographics, face-to-face and medical justification documentation from referrals to meet documentation expectations for Mercy Assisted Care per Federal, State and payer requirements.
• Maintains current knowledge of relevant documentation requirements for products provided by Mercy Assisted Care.
• Processes and submits prior authorizations for insurance approval of equipment rental or purchase.
• Responsible for entering accurate work order information, selecting appropriate supplies and/or equipment and delivery method for a seamless delivery. Maintains assigned Operator Tasks to ensure timely follow up with tasks.
• Schedules repairs for on-site repair technician.
• Reviews and obtains valid prescriptions through the Rx workflow.
• Reviews, routes and processes faxes through the fax workflow.
• Problem solves a wide range of customer issues and complaints, appropriately referring issues outside their scope of practice.
• Works with MAC purchasing department to subcontract orders from outside vendors for Mercy system patients.
• Must be able to select appropriate products given patient's medical need, life style and overall condition. Familiar with contraindication of all products and liability issues for MAC.
• Acts as liaison between Mercy Assisted Care and key internal and external customers/ referral sources.
• Responsible for maintaining and working the auto reorder program for supplies
• Maintain up-to-date, accurate information regarding equipment to meet accreditation and regulatory requirements.
• Verify patient's demographic/insurance (payer) information to ensure accurate input to billing for reimbursement.
• Monitor reports for timely renewals of prescriptions, prior authorizations, rentals and missing information.
• Responsible for absorbing and applying information provided in Customer Service Huddles, Customer Service meetings and MAC all staff meetings.

Education and Experience

High school diploma or equivalent; or 1 year's related experience and/or training; or equivalent combination of education and experience.

Special Physical Demands

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. Must be able to read and write in English. The employee must occasionally lift and/or move up to 10 pounds. These Special Physical Demands are considered Essential Job Functions of the position with or without accommodations.

Mercyhealth offers a generous total rewards package to eligible employees including, but not limited to:

* Comprehensive Benefits Package: Mercyhealth offers a retirement plan with competitive matching contribution, comprehensive medical, dental, and vision insurance options, life and disability coverage, access to flexible spending plans, and a variety of other discounted voluntary benefit options.

* Competitive Compensation: Mercyhealth offers market competitive rates of pay and participates in various shift differential and special pay incentive programs.

* Paid Time Off: Mercyhealth offers a generous paid time off plan, which increases with milestone anniversaries, to allow employees the opportunity for a great work-life balance.

* Career Advancement: Mercyhealth offers a number of educational assistance programs and career ladders to support employees in their educational journey and advancement within Mercyhealth.

* Employee Wellbeing: Mercyhealth has a focus on wellbeing for employees across the organization and offers a number of tools and resources, such as an employer-sponsored health risk assessment and a Wellbeing mobile application, to assist employees on their wellbeing journey.

* Additional Benefits: Mercyhealth employees have access to our internal and external employee assistance programs, employee-only discount packages, paid parental and caregiver leaves, on-demand pay, special payment programs for patient services, and financial education to help with retirement planning.