Experienced Customer Service Representative – Remote Medicare Appeal Support and Resolution Specialist

Welcome to Acentra Health: Empowering Better Health Outcomes Invest in your future with this career-defining role as a Customer Service Representative at Acentra Health, where we empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. As a hybrid role, you will have the flexibility to balance your time between our remote office and home, offering you the autonomy to work in a setting that suits you best. Acentra Health is the result of the merger between CNSI and Kepro, bringing together a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. Our people are at the heart of everything we do, and we are committed to providing you with meaningful work that genuinely improves people's lives across the country. Job Summary: Customer Service Representative The Customer Service Representative is responsible for supporting the Medicare Appeal process by answering incoming telephone calls, resolving customer questions, complaints, and requests, adhering to internal policies and procedures, and utilizing working knowledge of the organization's services to meet productivity and quality standards. This is a remote position, offering you the flexibility to work from the comfort of your own home. Key Responsibilities: Develop and maintain working knowledge of internal policies, procedures, and services (both departmental and operational) Utilize automated systems to log and retrieve information, performing accurate and timely data entry of electronic faxes Receive inquiries from customers or providers by telephone, email, fax, or mail, and communicate responses within required turnaround times Respond to telephone inquiries and complaints in a prompt, accurate, and courteous manner, following standard operating procedures Interact with hospitals, physicians, beneficiaries, or other program recipients, providing exceptional customer service and support Investigate and resolve or report customer problems, identifying and escalating difficult situations to the appropriate party Meet or exceed standards for call volume and service level per department guidelines, ensuring that customers receive the highest level of service Initiate files by collecting and entering demographic, provider, and procedure information into the system, maintaining accurate and up-to-date records Serve as a liaison between the Review Supervisors and external providers, facilitating effective communication and collaboration Maintain logs and documents disposition of incoming and outgoing calls, ensuring that all interactions are properly recorded and tracked Essential Qualifications: High School diploma or equivalent 2+ years of customer service/telephone experience in a similar call center environment and/or industry Ability to effectively communicate with team members and external customers, providing clear and concise information Ability to research and resolve issues related to Medicaid program and service eligibility, utilizing knowledge of relevant policies and procedures Bilingual (Spanish/English), with the ability to communicate effectively with diverse customer populations Preferred Qualifications/Experience: Previous experience in the medical office or other medical setting, with knowledge of medical terminology and procedures General knowledge of eligibility verification (Medicaid eligibility and program requirements for specific program of focus) Knowledge of CPT and HCPCS codes, with the ability to apply this knowledge in a customer service setting PC proficiency to include Microsoft Office Suite, with the ability to utilize automated systems and software applications Experience with Microsoft programs, with the ability to learn and adapt to new software and technologies Career Growth Opportunities and Learning Benefits At Acentra Health, we are committed to providing our employees with the tools and resources they need to succeed and grow in their careers. As a Customer Service Representative, you will have access to training and development programs, designed to help you build your skills and knowledge in customer service, Medicare appeals, and healthcare operations. You will also have opportunities to advance within the company, taking on new challenges and responsibilities as you grow and develop in your role. Work Environment and Company Culture Acentra Health is a dynamic and supportive work environment, where our employees are valued and respected. We believe in fostering a culture of collaboration, innovation, and excellence, where our employees can thrive and grow. As a remote employee, you will be part of a virtual team, working closely with colleagues and leaders to achieve our mission and goals. You will also have access to a range of benefits and perks, designed to support your well-being and quality of life. Compensation, Perks, and Benefits The pay range for this position is $15.85 - $18.20, depending on experience and qualifications. In addition to competitive compensation, we offer a range of benefits, including comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, and corporate discounts. We also provide opportunities for professional development and growth, with training and development programs designed to help you build your skills and knowledge. Conclusion: If you are a motivated and customer-focused individual, looking for a challenging and rewarding role in a dynamic and supportive work environment, we encourage you to apply for this exciting opportunity. As a Customer Service Representative at Acentra Health, you will have the chance to make a real difference in the lives of our customers, while growing and developing your skills and knowledge in a rapidly evolving industry. Don't miss out on this opportunity to join our team and contribute to our mission of empowering better health outcomes. Apply now and take the first step towards a rewarding and challenging career with Acentra Health! Visit us at Acentra.com/careers/ to learn more about our company and our career opportunities. We are an Equal Opportunity Employer, committed to diversity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State or Local law. Apply for this job