Customer Service Representative – Healthcare / Medical Insurance
(Health Claims Processing)
Center City, Phila., PA Location
We are growing our Department and are looking for a skilled problem solver to join our team as a Customer Service Representative who is knowledgeable with Healthcare Claims and Medical Insurance billings.
We need an enthusiastic individual who can listen to the customer and offer a unique and innovative solution to each problem.
The successful candidate for this role will have a strong command of the company’s customer service policies and be well-trained to offer quick and accurate assistance to customers.
For now, this role would be working on a remote basis until the Covid situation is reassessed. Once back on-site in our Center City, Phila., PA office, this role will work within a Call Center Environment (with proper Social Distancing procedures in place).
This is a full time, permanent opportunity with Monday-Friday hours of 8:30 am – 4:30 pm (lunch).
Our Center City Office is located close to Public Transportation.
* Manage incoming calls and customer service inquiries from Members, Doctors, Hospitals, and other professionals via telephone, e-mail, or fax regarding Audited Claims, Appeals, and balance bill requests.
* Maintain HIPAA compliance while communicating via telephone or written correspondence.
* Reviews Billing statements and EOBs to identify if a bill is a balance bill and request additional information OR, if it needs to be transferred to Level 2 triage, when necessary.
* Provide direction/guidance for bills where patient responsibility is owed.
* Determine level of reimbursement based on established criteria and communicate appropriately.
* Ensure caller received all the necessary documentation related to an audit. Determine and clearly communicate next steps and or transfer call to level 2 triage.
* Identify and transfer call to the appropriate area for inquiries that are not related to audit or balance bill inquiry.
* Create call tracking records and route to appropriate call tracking folders for resolution.
* Coordinates workflow with clerical support and other staff members.
* Perform additional duties and projects as assigned by management.
We are an Affirmative Action – Equal Opportunity Employer (Minorities/Females/Vets/Disabled). We provide equal opportunities to all employees and applicants for employment without regard to sex, race, color, religion, marital status, national origin, age, genetic information, sexual orientation, gender (including gender identity/expression), disability, veteran status and military status, pregnancy or pregnancy-related medical conditions, or any other factor that may be protected by law.
* High School Diploma or GED required; Some College or Degree preferred
* Minimum two (2+) years of experience in Health Claims processing required, preferably in a high-volume Call Center environment
* Knowledge of standard billing rules and claims coding (i.e. CPT, ICD, DRG and HCPCS).
* Proven experience in delivering solutions based on customer needs.
* Experience using web-based applications, Microsoft (word, excel, etc.).
* Excellent written and verbal communication skills as well as great interpersonal skills.
* Ability to multi-task, prioritize and manage time effectively.
* Must be able to maintain a pleasant professional attitude to ensure excellent service to members and providers.
* Must meet performance standards including attendance and punctuality.
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