The Customer Service Representative assists with held revenue by validating documentation, communicating with payers and customers, and applying medical policy knowledge to resolve claim issues. They also monitor accounts for barriers, identify trends to improve revenue flow, and maintain accurate records in compliance with departmental standards.
The Customer Service Rep - CHRG assists with held revenue by collecting required documentation, communicating with customers, and applying payer medical policy knowledge in alignment with standard operating procedures.
Identifies opportunities that enhance operational efficiency and improve overall results
JOB FUNCTIONS
Assists with held revenue by obtaining, reviewing, and validating required documentation to support claim resolution
Communicates with customers, payers, and internal teams to gather information, clarify requirements, and resolve outstanding issues
Applies knowledge of payer medical policies, coverage criteria, and reimbursement guidelines to ensure accurate claim processing
Follows established standard operating procedures to maintain compliance, consistency, and quality in all workflows
Monitors accounts for delays, missing documentation, or policy-related barriers and takes proactive steps to resolve them
Identifies trends, gaps, or recurring issues that impact revenue flow and escalates or recommends solutions as appropriate
Collaborates with team members to streamline processes, enhances operational efficiency, and improve overall performance results
Maintains accurate records, notes, and documentation within company systems to support audit readiness and transparency
Meets productivity, quality, and turnaround time expectations as defined by departmental standards
Participates in training, policy updates, and continuous improvement initiatives to stay current with payer requirements and internal processes
Qualifications
Education
High School Diploma or General Education Degree (GED), Required
Work Experience
1 year or more in held revenue, accounts receivable, medical billing, or related healthcare reimbursement functions, preferred
healthcare industry, durable medical equipment (DME), or insurance verification is a plus
Knowledge, Skills, and Abilities
payer requirements, medical policies, and coverage guidelines, preferred
Proficiency with Microsoft Excel and Word, including data entry, documentation management, and basic reporting
Strong attention to detail to analyze account information and identify discrepancies
Effective written and verbal communication for interacting with customers, payers, and internal teams
manage multiple tasks, prioritize workload, and meet productivity and quality expectations
Comfortable working in a fast paced, process driven environment with evolving payer requirements
This position requires use of your own equipment
Internet Service Type: Cable or Broadband
Network Firewall on the Internet Connection
Connection Type: Wired to ISP Modem
Latency to Florida or Tennessee Data Centers / Ping: < 30ms
“I was the first applicant for a remote marketing position that got listed on the company website the same day I applied. Had an interview within 48 hours!”
— Sarah J.
·
Marketing Manager
★★★★★
Verified
