Customer Service Representative

Customer Service Representative

The Customer Service Representative is responsible for supporting the Medicare Appeal process by answering incoming telephone calls, resolving customer questions, complaints and requests adhering to internal policies and procedures and utilizing working knowledge of the organization's services to meet productivity and quality standards. Job Responsibilities:

1. Develops and maintains working knowledge of internal policies, procedures, and services (both departmental and operational)
2. Utilizes automated systems to log and retrieve information. Performs accurate and timely data entry of electronic faxes
3. Receives inquiries from customers or providers by telephone, email, fax, or mail and communicates response within required turnaround times
4. Responds to telephone inquiries and complaints in a prompt, accurate, and courteous manner following standard operating procedures
5. Interacts with hospitals, physicians, beneficiaries, or other program recipients Investigates and resolves or reports customer problems. Identifies and escalates difficult situations to the appropriate party
6. Meets or exceeds standards for call volume and service level per department guidelines
7. Initiates files by collecting and entering demographic, provider, and procedure information into the system
8. Serves as liaison between the Review Supervisors and external providers
9. Maintains logs and documents disposition of incoming and outgoing calls

Experience/Skills Required:

• High School diploma or equivalent
• 2+ year's customer service/telephone experience in a similar call center environment and/or industry.
• Must have ability to effectively communicate with team members and external customers
• Must have ability to research and resolve issues related to Medicaid program and service eligibility

Experience/Skills Preferred:

• Previous experience in the medical office or other medical setting preferred
• General knowledge of eligibility verification (Medicaid eligibility and program requirements for specific program of focus preferred)
• Knowledge of CPT and HCPCS codes preferred
• PC proficiency to include Microsoft Office Suite Experience with Microsoft programs