CUSTOMER SERVICE REPRESENTATIVE
The Customer Service Representative (CSR) supports the Centers for Medicare & Medicaid Services (CMS) Payment Error Rate Measurement program for Medicaid and Children’s Health and Insurance Program (CHIP). This position provides unbiased assistance to answer customer questions, assistance with problem resolution and documenting all provider encounters in clear and concise logs.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Essential duties and responsibilities include the following. Other duties may be assigned.
Responsible for the integration of CNI Core Competencies into daily functions, including: commitment to integrity, knowledge / quality of work, supporting financial goals of the company, initiative / motivation, cooperation / relationships, problem analysis / discretion, accomplishing goals through organization, positive oral / written communication skills, leadership abilities, commitment to Affirmative Action, reliability / dependability, flexibility and ownership / accountability of actions taken.
Calls selected medical providers to request records for services they provided in support of an audit for Medicaid and CHIP programs.
Annotates the database and initiates the process to send medical record request packet to the provider.
Makes phone calls, using a script as a guide, and answers provider questions.
Provides records processing support to include scanning, indexing, and performing quality reviews of medical records received.
Maintains the confidentiality of patient information in accordance with HIPAA regulations.
Annotates call center system with clear and concise summary of communication with providers.
Requests contact information and medical records, and addresses the concerns of providers who need further clarification of their responsibilities.
Verifies provider billing information received from states.
Issues provider letters requesting medical record documentation.
Follows up with providers who have not sent in records since the first request was submitted.
Makes insufficient and additional documentation request calls and sends letters to providers.
Records all results from contacts in call center database.
Processes records received by fax in the document management system.
Receives, prepares, and scans, hard copies of records received in the mail.
Indexes records so images are organized for easy reference by reviewers.
Destroys hard copies of records in accordance with approved procedures.
Understands and abides by A+ security and HIPAA policies including patient information confidentiality.
Responsible for aiding in own self-development by being available and receptive to all training made available by the company.
Plans daily activities within the guidelines of company policy, job description and supervisor’s instruction in such a way as to maximize personal output. Responsible for aiding in own self-development by being available and receptive to all training made available by the company.
Responsible for keeping own immediate work area in a neat and orderly condition to ensure safety of self and coworkers. Will report any unsafe conditions and/or practices to the appropriate supervisor and human resources. Will immediately correct any unsafe conditions to the best of own ability.
High school diploma or general education degree (GED) and a minimum of two (2) years relevant experience and/or training, or equivalent combination of education / experience. Familiarity with Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) codes, and the Healthcare Common Procedure Coding System (HCPCS). Experience with medical record formats and content.
JOB SPECIFIC KNOWLEDGE / SKILLS / ABILITIES
- Outstanding customer service and relationship-building skills with ability to anticipate and meet customer needs
- Skilled in facilitating teamwork and coordinating efforts for the successful achievement of goals
- Exceptional organization, problem-solving and critical thinking skills
- Excellent verbal and written communication skills
- Excellent listening and problem resolution skills
- Ability to effectively interact with a large, diverse customer population
- Ability to manage multiple tasks simultaneously
- Ability to make sound, well-informed and objective decisions; perceives the impact and implications of decisions
- Ability to organize work and set priorities
CERTIFICATES, LICENSES, REGISTRATION
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Ability to read, analyze, and interpret general business periodicals, professiona1journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.