Customer Service Rep.

Location:            Framingham, MA 01702

Duration:            4  Months With Possible Extension

Job Title:            Customer Service Rep.

Shift       :            8:00 AM to 5:00 PM


Job Description:
Directs telephone contacts or written inquiries to appropriate personnel. Answers non-technical questions regarding company products.
Maintains log of incoming "hotline" contacts. Performs, as a skilled worker, a number of Contact Center tasks.
Determines, based upon professional knowledge, HOW best to approach the task and how to solve abnormalities.
Analyses abnormalities that occur within own working area and reasons, based upon professional knowledge and insights, where the cause lies and remedies it.
Completes work with a limited degree of supervision.
Job Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with all stakeholders.
o          Obtain authorizations for services and enter authorization, insurance, and demographics accurately and timely.
o          Accurate and timely entry of CPT and diagnosis codes and the relevant authorizations to ensure clean claims are released.
o          Communicate proactively of billing issues.
o          Ensure all claims are submitted with a goal of zero errors.
o          Verify completeness and accuracy of all claims prior to submission.
o          Timely follow up on insurance claim denials, exceptions or exclusions.
o          Read and interpret insurance explanation of benefits.
o          Respond to inquiries from case managers, insurance companies, patients and providers and internal customers such as sales.
o          Regularly attend monthly staff meetings and continuing educational sessions as requested.
o          Perform additional duties and projects as requested.
o          Education Requirements: High School Diploma, or equivalent. Associates Degree in Medical Billing and Coding or Accounting, preferred. Two years of experience in lieu of education may also be considered.
o          Years of Experience/Training: Minimum of 2- 5 years of experience in medical billing, preferably with Medicaid and Managed Care reimbursement.
o          Computer experience is essential. Must be technically savvy and comfortable using software, including, but not limited to: billing software, MS Office, Insurance Portals, and Electronic Claims Submissions. High aptitude to learn new programs, system integrations, and business processes.
o          Experience in CPT and ICD-10 coding; familiarity with medical terminology.

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