Customer Service Rep

Customer Service Rep - CHRG

The Customer Service Rep - CHRG assists with held revenue by collecting required documentation, communicating with customers, and applying payer medical policy knowledge in alignment with standard operating procedures.

Job Functions

• Assists with held revenue by obtaining, reviewing, and validating required documentation to support claim resolution
• Communicates with customers, payers, and internal teams to gather information, clarify requirements, and resolve outstanding issues
• Applies knowledge of payer medical policies, coverage criteria, and reimbursement guidelines to ensure accurate claim processing
• Follows established standard operating procedures to maintain compliance, consistency, and quality in all workflows
• Monitors accounts for delays, missing documentation, or policy-related barriers and takes proactive steps to resolve them
• Identifies trends, gaps, or recurring issues that impact revenue flow and escalates or recommends solutions as appropriate
• Collaborates with team members to streamline processes, enhances operational efficiency, and improve overall performance results
• Maintains accurate records, notes, and documentation within company systems to support audit readiness and transparency
• Meets productivity, quality, and turnaround time expectations as defined by departmental standards
• Participates in training, policy updates, and continuous improvement initiatives to stay current with payer requirements and internal processes

Education

• High School Diploma or General Education Degree (GED), Required

Work Experience

• 1 year or more in held revenue, accounts receivable, medical billing, or related healthcare reimbursement functions, preferred
• Healthcare industry, durable medical equipment (DME), or insurance verification is a plus

Knowledge, Skills, and Abilities

• Payer requirements, medical policies, and coverage guidelines, preferred
• Proficiency with Microsoft Excel and Word, including data entry, documentation management, and basic reporting
• Strong attention to detail to analyze account information and identify discrepancies
• Effective written and verbal communication for interacting with customers, payers, and internal teams
• Manage multiple tasks, prioritize workload, and meet productivity and quality expectations
• Comfortable working in a fast paced, process driven environment with evolving payer requirements