• Customer Service Representative III

    Job Locations US-VA-Glen Allen
    Job ID
    2018-4835
  • Overview

    The position is responsible for taking incoming provider calls for the Claims Customer Service Department. 

    This position is also responsible for handling all research/adjustment items received in the Claims Customer Service department.

    Responsibilities

    • Handle all incoming calls quickly and efficiently while delivering quality customer service to the caller.
    • Document all incoming provider calls in Pivotal
    • Handle all incoming research and adjustment items from the Call Center with resolution including Faxed requests and Macess Reconsiderations
    • Complete ChangeGear tickets assigned within established timeframes
    • Work claims reports and special projects as directed by Management
    • Ability to adjudicate claims in current inventory as directed by Management
    • The ability to work overtime as needed

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • High School diploma required

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Strong communication skills (both verbal and written)
    • Exposure to health care call center environment
    • Problem Resolution Skills
    • Ability to work independently as well as in a team environment
    • Strong organizational skills
    • Strong Time Management skills
    • Strong Knowledge of CPT-4, HCPCS coding and ICD-9/ICD10
    • Strong Knowledge of CMS 1500 and UB04 claim forms
    • Ability to meet deadlines and work under pressure
    • Ability to work independently as well as with others
    • Knowledge of various types of medical claims ( Primarily Skilled Nursing Facility, Behavioral Health, Personal & Respite Care, Home Health, Hospice DME, and Dialysis claims) 

    WORK BACKGROUND/EXPERIENCE

    • Minimum 3-5 years’ experience in customer service
    • Minimum 3-5 years claim processing experience, preferably with VPHP
    • Knowledge of IDX/QNXT Claim processing

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position

    About Us

    Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

     

    We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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