Customer Service Representative

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. They are looking for a Customer Service Representative to answer incoming calls and resolve customer inquiries while adhering to internal policies.

Responsibilities:

• Develop and maintain working knowledge of internal policies, procedures, and services
• Utilize automated systems to log and retrieve information; perform accurate and timely data entry
• Receive inquiries by telephone, email, fax, or mail and communicate responses within required turnaround times
• Respond to telephone inquiries in a prompt, accurate, and courteous manner
• Interact with external partners such as hospitals, physicians, beneficiaries, or other program recipients
• Perform verification of healthcare services to facilitate payment for received services
• Identify medical claims meeting CPT/DRG audit criteria and submit the necessary billing data
• Serve as liaison between the internal and external partners
• Investigate and resolve or report provider problems
• Meet or exceed standards for call volume and service level per department guidelines
• Initiate cases by collecting and entering demographic, provider, and procedure information into the system
• Complete daily, monthly, and quarterly reports necessary for clinical team operations
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Requirements:

• High School diploma or equivalent
• Minimum of two years of customer service experience
• Medical terminology course(s) or knowledge of medical terminology
• Knowledge of the health insurance industry
• Effective verbal and listening skills
• Bilingual Spanish-English a plus