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Call Center Agent
A call center agent is an employee that manages inbound or outbound customer calls for an organization. An agent may handle a wide range of responsibilities from account inquiries, customer complaints, or product and support issues. Today call center agents go by many names including: customer service representative (CSR), contact center agent or associate, or operator.
USRN and PHRN
Responsible for collaboration with healthcare providers and members to promote quality member outcome, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
Works with medical directors in interpreting appropriateness of care.