Customer Service Advisor
On-siteDetroit, Michigan, United States
Job Summary
Answer all customer service calls, determine service issues, and provide actions to reduce, terminate, suspend, or deny services. Receive, record, and resolve grievances, appeals, and Recipients Rights requests by uploading them into the DWIHN MH-WIN system and forwarding them to the appropriate units. Manage billing, medical records, and dispute resolution timelines, including State Fair Hearing forms and alternate dispute requests. Maintain clinical documentation, communicate effectively orally and in writing, and protect client information in compliance with HIPAA and organizational ethics. Participate in annual Grievance and Appeals training and continuing education to uphold NPRC standards.
Required Qualifications
- Complete and pass a criminal background check and obtain clearance
- Minimal high school diploma with at least one year of college experience
- Bachelor's degree in Health & Human services field
- Competent computer skills (Microsoft Suite)
- Communicate well verbally
- Conflict resolution skills
- Customer service
- Dedication to quality
- Problem solver
- Listening skills
- Recognizes PHI and protects client information and confidentiality
- Ensure NPRC standards procedure on policy is understood and upheld
- Maintains compliance with the organizations Code of Ethics and Confidentiality policies in accordance with the Health Insurance Portability and Accountability Act (HIPAA) regulation
Desired Qualifications
- at least one year of college experience
- Bachelor's degree in Health & Human services field preferred
- Certification recognized by the Michigan Certification Board of Addiction Professionals (MCBAP) in the State of Michigan as a Substance Abuse Counselor
- has an approved development plan
- Certification recognized by the Michigan Certification Board of Addiction Professionals (MCBAP) in the State of Michigan as a Substance Abuse Counselor or has an approved development plan (preferred but not required)
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