Customer Service Representative (CSR)

Position Description & Qualifications

The Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) program plays a vital role in safeguarding the integrity of the Medicare Fee-for-Service (FFS) program by ensuring that taxpayer-funded healthcare payments are accurate, appropriate, and compliant with federal requirements. Supporting CMS's obligations under the Payment Integrity Information Act (PIIA), the program uses statistically valid sampling and independent medical review of claims to identify improper payments and measure program performance. The insights generated through CERT enable CMS to strengthen accountability, improve healthcare delivery practices, and drive corrective actions that protect both beneficiaries and public funds. Through this work, the CERT program helps uphold transparency, stewardship, and trust in one of the nation's most critical healthcare systems.

This position courteously and professionally contacts and communicates with providers to obtain required medical record documentation as early as possible. The CSR works in a fast-paced challenging environment using clear, concise descriptions of the requested provider documentation to avoid misunderstanding and the need for repeated follow-up calls.

Candidates with prior CERT experience preferred. Prefer bilingual (Spanish speaking) candidates. Requesting candidate be fluent in speaking, reading, and understanding of Spanish.

Accountabilities:

• Requests records and information from Providers

• Responds to telephone inquiries promptly, professionally, and efficiently to provide resolution

• Analyzes provider questions to determine best use of resources to resolve the situation

• Serves as liaison between the providers and the various departments or team members in response to inquiries

• Professionally responds to all written inquiries (letter, fax, e-mail)

• Processes rejected records that do not meet initial inspection criteria and contacts Providers to resubmit legible copies

• Assists the providers in identifying what is being requested and answers their queries

• Provides records to the Medical Records Clerks for MRS assignment

• Assists with Medical Record Clerk workload as needed

• Maintains competency and attends required education and training programs

• Complies with all departmental protocols, policies and procedures

• Performs other duties as assigned by Medical Records Manager

Skills, Knowledge, Abilities:

• Proficiency with computers and computer software, specifically MS Word and MS Excel

• Ability to work within a call center environment and handle multiple phone lines throughout the business day

• Ability to be able to speak clearly and articulate in a professional manner

• Maintains a neat, organized work area

• Ability to work with others in a team environment

• Familiarity with department equipment (computers, copiers, fax machines, scanners)

• Ability to perform record imaging after training

• Ability to do record filing and retrieval

• Knowledge of medical record processing and procedures

• Knowledge of medical terminology

• Knowledge of healthcare and Medicare forms, documentation, and facilities

Education:

• Associates Degree in any of the following disciplines:

• Medical Records

• Marketing/Business/Sales

• Criminal Justice

• Computer Science

• Or high school diploma or a G.E.D and two years of customer service, call center and/or medical record experience and/or criminal justice/troubleshooting experience

Experience:

• At least six months of customer service experience with Call Center detail

Company Overview

Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco's 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.

To review Serco benefits please visit: . If you require an accommodation with the application process please email: View email address on click.appcast.io or call the HR Service Desk at View phone number on click.appcast.io, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.

Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.

Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email View email address on click.appcast.io .

Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

Pay Transparency

Our Total Rewards package includes competitive pay, performance-based incentives, and benefits that promote well-being and work-life balance-so you can thrive both professionally and personally. Eligible employees also gain access to a wide range of benefits from comprehensive health coverage and health savings accounts to retirement plans, life and disability insurance, and time-off programs that support work-life balance. Program availability may vary based on factors such as contract type, location, hire date, and applicable collective bargaining agreements.

Salary range: The hourly amount for this position can be found at the top of this posting. This role is covered by the Service Contract Act.?For positions on this contract, we will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor and the Wage Determination (WD). The wage rate will vary depending on the locality. Additionally, you will receive Health and Welfare Benefits based on the WD for the contract. Benefits - Comprehensible benefits for full-time employees (part-time members receive a limited package tailored to their role):

• Medical, dental, and vision insurance

• Robust vacation and sick leave benefits, and flexible work arrangements where permitted by role or contract

• 401(k) plan that includes employer matching funds

• Tuition reimbursement program

• Life insurance and disability coverage

• Optional coverages that can be purchased, including pet insurance, home and auto insurance, additional life and accident insurance, critical illness insurance, group legal, ID theft protection

• Birth, adoption, parental leave benefits

• Employee Assistance Plan that includes counseling conditions

• Specific benefits are dependent upon the specific contract as well as whether the position is covered by a collective bargaining agreement or Service Contract Labor Standards.

To review all Serco benefits please visit: .

Serco complies with all applicable state and local leave laws, including providing time off under the Colorado Healthy Families and Workplaces Act for eligible Colorado residents, in alignment with our policies and benefit plans. The application window for this position is for no more than 60 days. We encourage candidates to apply promptly after the posting date, as the position may close earlier if filled or if the application volume exceeds expectations. Please submit applications exclusively through Serco's external (or internal) career site. If an applicant has any concerns with job posting compliance, please send an email to: View email address on click.appcast.io .