Customer Service Representative (Bilingual - Remote - SCA)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. They are seeking a Bilingual Customer Service Representative to support the Medicare Appeal process by addressing customer inquiries and resolving issues while adhering to internal policies and procedures.

Responsibilities:

• Develops and maintains working knowledge of internal policies, procedures, and services (both departmental and operational)
• Utilizes automated systems to log and retrieve information. Performs accurate and timely data entry of electronic faxes
• Receives inquiries from customers or providers by telephone, email, fax, or mail and communicates response within required turnaround times
• Responds to telephone inquiries and complaints in a prompt, accurate, and courteous manner following standard operating procedures
• 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
• Meets or exceeds standards for call volume and service level per department guidelines
• Initiates files by collecting and entering demographic, provider, and procedure information into the system
• Serves as liaison between the Review Supervisors and external providers
• Maintains logs and documents disposition of incoming and outgoing calls
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Requirements:

• Requires a High School diploma or equivalent
• Requires a minimum of two years of customer service experience
• Bilingual (Spanish/English)
• Must have ability to research and resolve issues related to Medicaid program and service eligibility
• PC proficiency to include Microsoft Office Suite
• Knowledge of medical terminology
• Knowledge of the health insurance industry
• Effective verbal and listening skills
• Knowledge of CPT and HCPCS codes preferred