Website CES, LLC
Integrity At Work
Job Description Summary:
The Customer Service Representative (CSR) courteously and professionally contacts and communicates with providers to obtain required medical record documentation in support of medical reviews for claims. The CSR works in a fast-paced, challenging environment using clear, concise descriptions of requested provider documentation.
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 Technician for MRT assignment.
Assists with Medical Record Technician workload as needed.
Maintains competency and attends required education and training programs.
Complies with all departmental protocols, policies and procedures.
Associates Degree or higher in Medical Records, Marketing/Business/Sales, Criminal Justice or Computer Science; or H.S. Diploma/GED with 2 years of experience in customer service, call center, medical record, or criminal justice
Ability to work within a call center environment and handle multiple phone lines throughout the business day. (Equipment for working from home will be provided.)
Proficiency with computers and computer software, specifically MS Word and MS Excel.
Ability to be able to speak clearly and articulate in a professional manner.
Ability to work with others in a team environment.
Familiarity with department equipment (computers, copiers, fax machines, scanners).
Ability to do electronic record filing and retrieval.
Knowledge of medical record processing and procedures
Knowledge of medical terminology.
Knowledge of healthcare and Medicare forms, documentation, and facilities.
Extensive knowledge of medical records and their components, and medical record practices, policies and procedures desired.
Prefer at least 6 months of customer service experience within a call center environment
Office Equipment Required: (This is a work from home position.)
Locking cabinet and/or desk for storing documents and electronic media
Broadband internet connection
Phone line (land line or cellular)
May require prolonged periods of sitting at a desk and working on a computer.
Must have no adverse actions pending or taken by any State or Federal licensing board or program
Fingerprint background check may be required.