Yohaira Plaza

• Use professional spoken and written etiquette and all available resources to respond to incoming customer inquiries, requests and complaints competently and courteously.
• Perform research and troubleshoot inquiries and follow up with customers on issues that cannot be resolved immediately.
• Research and resolve more complex customer issues, including those referred by other teams, as part of established processes and/or protocols.
• Complete all required documentation associated with the handling of received requests while maintaining complete and accurate records.
• As needed, report priority and critical matters to clients and relevant internal parties following established procedures for reporting and documentation.
• Follow all policies regarding follow-up and shift change notification.
• Follow up with relevant parties as needed, based on the issue being addressed.
• Follow through in a timely manner to resolve all issues and concerns.
• Provide complete and accurate information, education and guidance to clients about business processes
• Escalate issues as appropriate to keep immediate supervisor informed of client concerns, problems or deviations from established procedures.
• May provide coaching and/or training to less experienced staff.
• Provide suggestions for process improvements to maximize quality and efficiencies in the department.
• Comply with company policies and governmental regulations.
• Perform other duties as assigned to meet the business needs or customer requirements.
• 6 years' experience in a similar role.
• Path Quest (QPS)
• Power Term (QLS)
• Pathway
• Proper telephone etiquette to handle customer inquiries.
• Basic knowledge of operating office equipment.
• Basic understanding of fundamental medical and laboratory terminology.
• Understand the importance of Quality Service and how it is measuredMicrosoft products. (Outlook, Teams, Word, Excel etc.)

• Perform insurance verification, pre-certification, and pre-authorization utilizing ICD-10 codes, medical terminology, and patient encounter forms.
• Verify clinical indication and correlation for test ordered in Oncology and Gastroenterology.
• Research denial concerns and report to management and billing teams in order to foster a bridge between pre-authorization and billing.
• Following acceptable department process deliver appropriate response to inbound and outbound tasks.
• Able to handle multiple tasks and work in a fast-paced environment displaying a professional attitude at all times.
• Attentive to detail with the ability to read and follow standard operating procedures and departmental processes.

• Ability to follow directions and take instruction from others.
• Report client concerns using established protocols.
• Escalate issues as appropriate using established protocols.
• Identify and escalate priority issues through proper channels.
• Utilize interpersonal skills to interact effectively with other team members and clients.
• Actively participant in team meetings and trainings.
• Maintain quality scores at or above the department standard.
• Consistently meets accurate documentation requirements and utilization of CRM and other Quest tools.
• Successful adherence to schedule and consistently meets established
performance and quality scores.
• Accountable to stay informed and apply client program details, department process updates and other communications.
• Provide research and resolution on complex issues, including those that are referred by CSR I.
• May coach and mentor new hires or less experienced staff.
• Performs other duties as required to meet business requirements.