Corizon Health, Inc. Brentwood , TN 37024
Correctional Care | Committed Careers | Corizon Health
We have an exceptional opportunity for a Customer Service Representative to join our Healthcare Support Team in Brentwood, TN.
Qualifications of the Corizon Health Customer Service Representative
High School graduate, Bachelor's degree preferred
Experience Level: 4+ years' experience in customer service and/or processing claims within a healthcare organization. Knowledge of ICD-9, CPT-4, HCPCs, and ADA guidelines, medical terminology, fee schedules and contracts.
Tools and Technology: ata entry, 10-key skills, Microsoft Outlook, Excel, Word, Qnxt system experience preferred
Certificates and Licenses: No certifications needed
Language Ability: Strong verbal and written and presentation communication skills. Effectively present information in one-on-one and group situations to customers, clients and other employees of the organization.
Reasoning Ability: Common sense understanding to carry out instructions furnished in written, oral or diagram form. Deal with problems involving several concrete variables in standardized situations.
Work Environment: Office environment. Subject to after-hours work to meet deadlines.
Physical Demands: Must have and maintain sufficient strength, agility, and endurance to perform during stressful (physical, mental and emotional) situations encountered on the job without compromising your health and well-being or that of your fellow employees.
Responsibilities of the Corizon Health Customer Service Representative
Research and respond to telephone calls, written inquiries and appeals coming in to the Provider phone lines. Serve as first point of contact for hospitals, physicians, other healthcare providers, and regional and site personnel on all claims related issues. Resolve all interactions in compliance with company standards and guidelines.
Respond to telephone calls and correspondence from hospitals, physicians, ancillary providers and Regional / site personnel regarding claim status, reimbursement details, payment dates, claim / service line denials and other claim related issues.Handle medical appeals, working with Utilization Management and the Nurse Auditor to resolve.Manage Special Projects for the Director, Claims Administration and the Legal Department, thoroughly researching and documenting findings involving potential litigation and/or settlements.Interface with on-site and off-site providers and site staff to resolve operational issues, improve processes and ensure medical service rendered to inmates is not interrupted due to payment related concerns.Conduct detailed research to determine appropriate resolution of inquiry and respond accordingly. This includes calling providers, vendors, site personnel and/or other CMS departments to obtain needed information.Analyze incorrectly adjudicated claims to determine if root cause is a Claims Examiner error or a system/ configuration problem and work with appropriate area (Eligibility, Provider Configuration, Claims) to resolve issues affecting claims processing.Understand the Code Review subsystem to accurately explain unbundling and billing edits/denials to providers.Maintain comprehensive knowledge of all client / provider contracts and third party payer arrangements.Utilize the Call Tracking subsystem to accurately record inquiries for tracking and trending.Interact with internal and external customers in a professional, knowledgeable and courteous manner.Maintain productivity and quality standards as set forth by management.Assist in completion of special projects on an as needed basis within the Department.Assist in completion of special projects on an as needed basis within the Department.Assist in completion of special projects and initiatives on an as needed basis.
Benefits offered to the Corizon Health Customer Service Representative
Paid Time Off
Medical, Dental and Vision Insurance
401(k) with Company Match
Corizon Health provides patients with high quality healthcare and reentry services that will reduce recidivism and better the communities where we live and work. We are dedicated to meeting the needs of the growing number of incarcerated persons with physical and mental illness and the professionals who care for them. More healthcare professionals are finding the stability and advancement they desire at Corizon Health.
This position may require a background check, security clearance, and/or drug screening.
Corizon Health is an Equal Opportunity Employer. In compliance with federal and state employment opportunity laws, qualified applicants are considered for all positions without regard to race, gender, national origin, religion, age, sexual orientation, disability, Vietnam era veteran, or disabled Veteran status.