• Customer Service Representative II

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5132
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The position is responsible for taking incoming provider calls for the MLTSS line of business.  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
    • Ability to conduct research
    • Experience with  QNXT Claim processing systems
    • Ability to work independently as well as in a team environment
    • Strong organizational skills
    • Strong Time Management skills
    • Knowledge of CPT-4, HCPCS coding and ICD-9/ICD10
    • Knowledge of CMS 1500 and UB04 claim forms
    • Ability to meet deadlines and work under pressure

    WORK BACKGROUND/EXPERIENCE

    • Minimum 2 years claim processing and call center experience

    PHYSICAL REQUIREMENTS

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

    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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