The specialist receives and responds to calls from members, providers, and pharmacies, making outbound calls and entering pharmacy overrides based on clinical pharmacist approvals. This role involves researching issues, resolving inquiries, and handling prior authorization requests while adhering to regulatory guidelines.

The specialist assists in responding to complaints and escalations from members and providers by handling problem tickets and providing feedback to senior staff. They serve as a liaison to maintain interdepartmental relationships to ensure timely and appropriate resolution of escalated issues.

The Customer Service Representative will provide critical, customer-focused assistance, primarily handling telephonic appointment scheduling, outreach calls, and managing email inboxes for the Behavioral Health program. Responsibilities also include registration paperwork, responding to complex customer inquiries, and monitoring the Electronic Health Record (Epic).

The role involves delivering a positive patient experience by clearly explaining financial responsibility and insurance benefits with empathy, while proactively contacting patients to review coverage and obtain payment information. Responsibilities also include creating accurate financial responsibility letters and managing patient demographic and referral information to ensure timely care delivery.