ROI
What does ROI stand for?
ROI = Release of Information
What is a premium?
Monthly payment members pay.
What Skill is listed on policy 802561156?
Small Employer
You are logging into work for the first time today, what do you do?
Clock in through Kronos & change status to "Other Training" through Genesys.
How many letters are in the alphabet?
26
How many identifiers are needed for a member to be considered verified?
3 (i.e. - First and Last name, DOB, Policy ID, Address, Phone Number, and last 4 of social)
Give an example of what would be covered by insurance by just paying monthly premiums.
Preventative services.
What does it state under the COB carrier for this policy 802842997?
SELECTHEALTH COMMUNITY CARE - SECONDARY
It’s noon, before going to lunch what do you do?
Meal Out in Kronos & change status to Lunch in Genesys
If you were a fruit or a vegetable, what would you be and why?
Answers Vary!
True or False: If a member rep calls in we need to grab their name, their relationship to the member, and 3 identifiers for the member. Once we have that they will be verified on the policy.
FALSE! We ALSO need to have an ROI on file.
**REMINDER: Educate them on the ROI form if they don't have ROI on file.
What is the difference between a deductible and out-of-pocket maximum?
Insurance will not pay claims until deductible is met; Insurance will pay 100% of claims once out-of-pocket maximum is met.
What is the name of the Broker on policy 802889694?
Hailey Eckstrom
Its 12:30pm and you’re coming back from lunch. Its Monday. What do you do?
Meal In in through Kronos & change status to Other Training in Genesys
What country has a unicorn as its national animal
Scotland
What is PHI? What would be considered a PHI violation?
PHI = Protected Health Information
Examples:
- Not locking your screens!!
- Leaving printed sensitive documents out in the open
What is the role of a Member Advocate?
A Member Advocate's main objective is to help members get care by finding providers. We have numerous ways of finding in-network options. This can include giving care options over the phone, scheduling appointments, and occasionally starting nonparticipating reviews.
If a member has Blue Cross Blue Shield listed as their primary insurance, how does that affect call flow?
We can still help find providers and schedule appointments like normal, we just want to let the caller know their primary coverage will go through their primary insurance and SH will follow suit.
You are leaving for the day after listening to phone calls with your mentor, what do you do?
Clock out of Kronos & log out of Genesys
How many ribs does a human skeleton have?
24
What does HIPPA stand for?
Health Insurance Portability and Accountability Act of 1996
What is the difference between co-pay and co-insurance?
Copay is a fixed dollar amount that the member pays providers for services (e.g. $25, $50, $35, etc.). Coinsurance is a percentage the members pay for services (e.g. 20%, 30%, 40%, etc.).
What does MPS stand for and where can you find it?
MPS = Member Payment Summary
You click on the plan description under the "Medical Plan Details" section.
How many times a day do you typically change your status to "break"?
Twice! You get a 15 min break @ 9:45 AM and another @ 2:45 PM.
How many keys does a piano have?
88