Customer Service Representative-Hospital

Customer Service Representative-Hospital
Shelby, Michigan
A Call Center Customer Service Representative Job is available right now in Shelby, Michigan. Do you have 3+ years in a high-volume call center environment with the ability to answer questions about healthcare providers and/or billing? This position is responsible for the processing all inbound provider calls for Medicaid, Medicare and BCBS. This position requires general knowledge of claims processing, authorization processes, billing and provider benefits. This position operates out of a phone queue and provides exceptional quality customer service to all providers.

  • Work within a call center environment to process incoming and outgoing telephone contacts with providers and patients regarding billing question
  • Adhere to workforce management schedules to ensure departmental goals are met
  • Conduct inbound telephone contact with providers in a professional manner and maintain phone stats according to departmental goals
  • Assist Medicaid, Medicare and BCBS providers with identified needs during telephone contacts
  • Determine if procedures require prior authorization by checking CPT codes at the request of providers
  • Assist providers by entering authorizations over the phone, when applicable
  • Fax processed authorization requests back to appropriate provider offices
  • Provide regular or complex claim status to providers over the phone
  • Run check tracers at the request of providers for lost or expired checks
  • Educate providers on policies and procedures regarding access to care, grievance and appeal process, eligibility process, HIPAA, rights and responsibilities, and fraud, waste and abuse
  • Educate providers on company s policies and procedures regarding access to care, grievance and appeal process and eligibility process
  • Consistently demonstrates compliance with HIPAA regulations, professional conduct and ethical practice
  • Provide excellent customer service to providers and internally to all Management Staff
  • Remain updated on all provider policy changes made by MHP, the State, or accrediting entities
  • Perform accurate data entry into systems and software programs
  • May be required to work holidays and/or observed holidays as requested by leadership
  • Perform other duties as assigned
  • High school diploma is required.
  • Bachelor s degree in one of the following areas is preferred: Allied Health, Business Administration (with a focus in Health Services Administration), Health and Fitness Management, Health Sciences (with a focus in Behavioral Health), Health Services Administration, Healthcare Administration, Healthcare Management, Nursing, Nutrition, Public Safety, Pharmacy, Psychology, Public Health or Social Work
  • 3+ years of customer service experience or related health care industry experience in a call center
  • Knowledge of managed care or Medicaid/Medicare and BCBS programs is helpful
  • Familiarity with Medical Terminology, ICD-10, and CPT codes
  • Must be familiar with claims ledger, timely filing process, and appeal and denial processes
  • Solid understanding of the full adjudication process
  • Excellent verbal and written communication skills are required
  • Intermediate computer skills are required
  • Research and follow-through skills
Organizational and team skills
Are you interested in this Customer Service Representative-Provider/Hospital job in Shelby, Michigan? Then click apply below!

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