Customer Service Representative – Healthcare / Medical Insurance – (Health Claims Processing)

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.

RESPONSIBILITIES:

* 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.