Full Time

Member Success Agent

Job Overview:

The Member Success Agent is the face of our organization and plays a critical role in delivering exceptional support to our members. This role requires a proactive, energetic individual who is passionate about customer service and thrives in helping others. As the first point of contact for our members, the Member Success Agent will manage member inquiries, troubleshoot issues, and collaborate across departments to ensure smooth, positive experiences that reflect our brand’s values.

Job details:

  • Monday to Friday | 10 PM to 7 AM Manila Time
  • Work from home
  • **Follows the US Holiday Calendar
    • New Year’s Day - January 1
    • Memorial Day - last Monday in May
    • Independence Day - July 4
    • Labor Day - 1st Monday in September
    • Veterans’ Day - November 11
    • Thanksgiving Day - 4th Thursday in November
    • Christmas Day - December 25

Responsibilities:

  • CRM Monitoring: Continuously monitor the CRM system for incoming messages, inquiries, and issues. Provide prompt, accurate responses while maintaining a high level of professionalism and empathy.
  • Member Engagement: Actively engage with members in private social network groups, offering support and assistance to ensure their needs are met and concerns addressed.
  • Phone and Email Support: Handle phone-based interactions as the primary support channel. Offer white-glove service by going above and beyond to meet member needs, including conducting quick Zoom sessions when necessary.
  • Liaison Between Departments: Serve as the bridge between the member and various internal teams, ensuring timely and accurate resolution of issues.
  • Onboarding Support: Facilitate onboarding calls for new members, guiding them through the setup process and managing the flow of information between them and the fulfillment department.
  • Data Verification: Conduct data verification checks during the onboarding process to ensure accuracy and completeness of member information in the CRM.
  • Documentation and Reporting: Ensure all customer interactions are thoroughly documented in the CRM system by the end of each day. Generate and submit reports as needed.
  • Continuous Improvement: Identify opportunities for enhancing member satisfaction and retention. Provide feedback and suggestions for improving processes and member engagement strategies.
  • Policy Adherence: Ensure consistent application of company policies and procedures to optimize customer experiences and create high-value interactions.

Qualifications:

  • At least 3+ years of professional experience in a customer service or customer success role.
  • Strong customer orientation with a desire to deliver the best possible member experience.
  • Proven ability to self-direct and manage time effectively, with a strong sense of urgency and autonomy.
  • Experience in building and maintaining strong relationships with customers.
  • Excellent communication skills, both written and verbal, with the ability to handle difficult conversations and de-escalate issues.
  • Familiarity with CRM systems (e.g., Go High Level), social media platforms, and ticketing systems is preferred.
  • Proficiency with Microsoft Word, Excel, Google Docs, and Sheets.
  • Ability to quickly learn and apply new information in a fast-paced environment.
  • Strong multitasking skills, with the ability to handle multiple customer interactions simultaneously without compromising quality.
  • Ability to make independent decisions based on training, company values, and established guidelines.
  • Commitment to documenting customer issues and ensuring proper follow-up.
  • Ability to work under pressure and meet tight deadlines.

by Carl Trinidad

Medical Coding Specialist - Outpatient / Inpatient

Position Summary:

The Medical Coding Specialist - Outpatient/Inpatient will be responsible for an advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10/PCS, CPT IV codes, based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes an array of inpatient and/or outpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association, (AHIMA) Coding Ethics, as well as all American Hospital Association, (AHA) Coding Clinics, CMS directives and bulletins, and Fiscal intermediary communications.

Job Details:

  • Medical Coding Specialist - Outpatient/Inpatient
  • Permanent work-from-home
  • Monday to Friday | 11 PM to 8 AM Manila Time
  • *Following US Holidays

Responsibilities:

  • Review and interpret medical record documentation for the purpose of accurate coding assignment for inpatient and/or outpatient records.
  • Assign correct ICD-10-CM, ICD-10/PCS, and CPT IV codes based on the analysis of medical record documentation, ensuring compliance with all relevant guidelines and regulations.
  • Abstract specific data elements from each case in accordance with federal regulations.
  • Maintain strict adherence to the Official Guidelines of Coding and Reporting, AHIMA Coding Ethics, AHA Coding Clinics, CMS directives and bulletins, and Fiscal intermediary communications.
  • Coordinate and communicate effectively with healthcare providers and administrative staff regarding coding and documentation issues.
  • Ensure consistency, accuracy, and integrity of coded data and utilize audits and data quality checks to maintain quality control.
  • Continually update and maintain coding knowledge and skills by attending educational workshops, reviewing professional publications, participating in professional societies, and leveraging other opportunities for professional growth.

Qualifications:

  • Current Coding Certification is required, which may include CCS, CIC, CPC, or COC (Preferred License is CPC or CCS Certification)
  • Proven experience in a similar role with a deep understanding of ICD-10-CM, ICD-10/PCS, and CPT IV coding.
  • Experience in multi-specialty coding.
  • Exceptional attention to detail, accuracy, and the ability to maintain high levels of confidentiality.
  • Strong computer skills and proficiency in using medical software, with Athena experience considered a plus.
  • Excellent communication skills, with the ability to interpret and clearly explain complex coding information.
  • The ability to work effectively both independently and as part of a team.

by Carl Trinidad

Medical Billing Specialist - AR

Position Summary:

The Medical Billing Specialist - AR will play a vital role in our financial team with the primary responsibility of handling all aspects of claims management, from investigation to resolution. This involves reviewing and analyzing the status of claims, navigating various online portals, and regularly communicating with payers. The position also requires a proactive approach towards the investigation and analysis of claim denials, finding effective solutions to ensure their payment, and consistently following up on any outstanding claims. The Accounts Receivable Specialist will report directly to the Accounts Receivable Supervisor/Manager and contribute to the effective and efficient operation of our financial management system.

Job Details:

  • Work from home
  • Monday to Friday | 9 PM to 6 AM
  • *Following Philippine Holidays

Responsibilities:

  • Navigate Different Online Portals: Regularly access various online systems to check the status of claims, ensuring they are processed correctly and in a timely manner.
  • Communicate with Payers: Contact payer hotlines for inquiries, clarifications, and the status of claims. Display professionalism and efficiency in all interactions to maintain positive relationships.
  • Investigate Claim Denials: Proactively investigate the reasons behind claim denials, analyze the information gathered, and develop effective solutions to ensure claim payments.
  • Manage Claim Adjustments: Resubmit claims, request reprocessing, send corrected claims, and/or create appeals as needed, based on analysis and investigation results.
  • Follow Up on Outstanding Claims: Diligently and promptly follow up on any open and unpaid claim until the Accounts Receivable list is cleared up, preventing untimely resubmission or appeal.
  • Report Regularly: Provide daily reports to the Accounts Receivable Supervisor/Manager about completed tasks and any pending issues, ensuring clear and concise communication about any updates or issues that require attention.
  • Maintain the Accounts Receivable System: Regularly update the Accounts Receivable system with clear, comprehensive notes to track progress and facilitate efficient claim management.

Qualifications:

  • At least 3 years experience in an accounts receivable role, with a focus on healthcare claims management.
  • Excellent ability to navigate and use various online systems and portals.
  • Strong communication skills, both verbal and written, for effective liaison with payers and internal stakeholders.
  • Proven analytical and problem-solving skills, with the ability to analyze claim denials and devise effective resolutions.
  • Attention to detail and high levels of accuracy in all tasks.
  • Ability to work effectively under pressure and manage multiple priorities.
  • Proficient in using accounts receivable software and other standard office software such as Microsoft Office.

by Carl Trinidad