Customer Service Representative (CSR)

About the role

The Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) program plays a vital role in safeguarding the integrity of the Medicare Fee-for-Service (FFS) program by ensuring that taxpayer-funded healthcare payments are accurate, appropriate, and compliant with federal requirements. This position courteously and professionally contacts and communicates with providers to obtain required medical record documentation as early as possible.

Responsibilities

• 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 Clerks for MRS assignment
• Assists with Medical Record Clerk workload as needed
• Maintains competency and attends required education and training programs
• Complies with all departmental protocols, policies and procedures
• Performs other duties as assigned by Medical Records Manager

Requirements

• Candidates with prior CERT experience preferred
• Prefer bilingual (Spanish speaking) candidates
• Requesting candidate be fluent in speaking, reading, and understanding of Spanish

Qualifications

Candidates should have an Associate's Degree in a relevant discipline, such as Medical Records, Marketing/Business/Sales, Criminal Justice, or Computer Science, or a high school diploma or G.E.D with at least two years of customer service, call center, and/or medical record experience.

Skills

• Proficiency with computers and computer software, specifically MS Word and MS Excel
• Ability to work within a call center environment and handle multiple phone lines throughout the business day
• Ability to speak clearly and articulate in a professional manner
• Maintains a neat, organized work area
• Ability to work with others in a team environment
• Familiarity with department equipment (computers, copiers, fax machines, scanners)
• Ability to perform record imaging after training
• Ability to do record filing and retrieval
• Knowledge of medical record processing and procedures
• Knowledge of medical terminology
• Knowledge of healthcare and Medicare forms, documentation, and facilities

Experience

At least six months of customer service experience with Call Center detail.

Benefits

• Comprehensive benefits for full-time employees, including medical, dental, and vision insurance
• Robust vacation and sick leave benefits, and flexible work arrangements where permitted by role or contract
• 401(k) plan that includes employer matching funds
• Tuition reimbursement program
• Life insurance and disability coverage
• Optional coverages that can be purchased, including pet insurance, home and auto insurance, additional life and accident insurance, critical illness insurance, group legal, ID theft protection
• Birth, adoption, parental leave benefits
• Employee Assistance Plan that includes counseling conditions

Pay

The hourly amount for this position is determined by the Service Contract Act and the Wage Determination (WD) for the contract, and includes Health and Welfare Benefits.

Schedule

This is a full-time position, with a standard work schedule and benefits package.