CSR/ Member Service Rep

Position Purpose:

• Receive and respond to telephone inquiries from members or providers regarding eligibility, benefits and authorization of services. Educate callers on behavioral health program and procedures.

Position Responsibilities:

• Receive and respond to all telephone inquiries from members or providers

• Research and provide information regarding member's eligibility, benefits, referrals and authorizations

• Provide members with information on the Provider Network and how to contact and access providers

• Educate providers on prior authorization requirements, how to access services and other routine, non-clinical issues

• Educate providers on process of submitting outpatient treatment requests for outpatient therapy

• Initiate or fax necessary forms to providers for outpatient therapy services

• Coordinate with Provider Relations regarding contracting and/or credentialing status

• Document all members' issues and resolution in the computer systems

• Provide backup support to Data Entry team as necessary