Provider Resources, LLC · 2 hours ago
IDRE Customer Service Representative CSR
United States
Full-time
Remote
Entry Level
$31K/yr - $44K/yr
4+ years expProvider Resources Inc is a trusted leader in healthcare, focused on driving integrity and advancing quality across the system. The Customer Service Representative (CSR) will efficiently answer inquiries from stakeholders, manage communications, and collaborate with team members to ensure effective resolution of requests and concerns.
EducationGovernmentHealth Care
No H1B
Security Clearance Required
Responsibilities
Understand and represent PRI mission, vision, and values to all internal and external customers
Interact with government and private sector clients, partners, and PRI staff in a professional and accountable manner, and as a representative of PRI management
Interact with project team members in order to successfully fulfill contract obligations with the highest quality and in a timely manner meeting PRI’s ISO requirements
Instills integrity throughout the organization via active participation in ISO requirements including but not limited to timely submission of Corrective Action Plans for all matters in which either PRI standards and/or corporate contract standards have not been met. Communicates outcomes to team members to ensure a positive, open, environment which mitigates risk and achieves a culture of Continuous Quality Improvement
Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client
Respond to telephone inquiries promptly, professionally, and efficiently to provide first call resolution
Understand and resolve customer requests, questions and provide analysis of situations to determine best use of resources
Obtain, evaluate and analyze all relevant information to successfully handle inquires
Serves as liaison between the customer and various departments or team members in response to inquires
Direct unresolved issues to designated departments or team members for further investigation if necessary
Participation in educating and communicating the program requirements to stakeholders
Respond to all written inquires (letter, fax, and email) in a professional manner
Keep records of stakeholder interactions and transactions
Record details of actions taken and provide followup and results orientation based upon established protocols
Identification of analysis of trends and reporting to management team
Maintain a communications log that documents all inquiries, including telephonic, written, and email
Actively participates in quality assurance activities; identifies trends and reports to management team
Recommend process improvement to management team (Lessons learned and Best Practices)
Maintain a high level of knowledge and comply with all protocols, policies and procedures
File all project documents (hard and soft copies)
Provide assistance as needed to team members
Perform other duties as assigned
Qualification
Required
Associates Degree with a minimum of two (2) years general related experience in lieu of a degree, 2 additional years of related experience is required
Ability to work in a high volume and high pressured call center
Familiarity with Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9CM) codes, and Healthcare Common Procedural Coding System (HCPCS) codes
Excellent communication skills, both verbal and written. Ability to speak clearly in a professional manner so the stakeholder can understand and comprehend the interview/survey questions
Possesses high level of time management and organizational skills
Must have excellent customer service, interpersonal, listening, and problem-solving skills
Consistently handles inquiries in the friendly and professional manner
Reliable, honest, and trustworthy; Integrity is required
Demonstrated ability to work with others in a team environment
Excellent data entry skills with high level of accuracy; able to work under production guidelines
Must be proficient in Microsoft Applications such as MS Word, Excel, and Access
Demonstration of adherence to deadlines
Flexibility to changing requirements and contingencies
Willing to take on additional tasks as required and learn new skills
Willingness and ability to undertake training needed in order to fulfill the changing requirements of the job
Ability to interface with all levels of management and staff personnel
Must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA)
Ability to obtain and maintain U.S. Government Security Clearance
Preferred
Candidates having experience with IDR, No Surprises Act or experience working in a customer service capacity with a health insurance company are preferred
Preference will be given to individuals who reside in, or are willing to relocate to, a recognized HUBZone area
Company
Provider Resources, LLC
Provider Resources, LLC (PRI) offers the federal healthcare space expert services in medical review and program integrity measures, education and training, healthcare quality initiatives, and policy & regulatory expertise - all aimed at instilling integrity into the healthcare system.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Shawn Keough-Hartz
CEO/President
William McBee, CFE-retired - LPI
Executive Vice President, Chief Compliance Officer
Company data provided by crunchbase