Pearl Interactive Network, Inc.
The Customer Service Representative (CSR) is responsible for responding to Medicare Part A and/or B telephone inquiries from the Medicare provider community which includes billing offices, medical societies, provider consultants, Managed Care Organizations, attorneys, etc. regarding Medicare Fee-for-Service coverage guidelines and policies covering a wide range of topics to include provider enrollment, Medicare appeals, debt recovery, claim payment information, telephone reopening requests, and general coverage for multiple provider specialties.
Why choose Pearl Interactive Network?
Join Our Team and embrace the winning Pearl Culture which promotes our employee's desires and efforts to serve our consumers, clients, and community. Our values of customer satisfaction, teamwork, a family atmosphere, quality services, respect for each other, transparency, and innovation are what make Pearl, the employer of choice. As a woman-owned, HUBZone certified social enterprise, Pearl offers hiring priority to our Veterans, Military Spouses, and their families, as well as individuals with disabilities.
Top EASIEST Ways To Earn Extra Cash Online!
1. PaidViewpoint - I've earned over $495! And love the fast payout via Paypal.
2. ACOP - Get paid for your opinion! (USA, Canada, UK, Germany & France).
3. Survey Junkie - Surveys & Product testing. Open in the USA, Canada, & Australia.
4. 1Q - Get paid .25 instantly into PayPal for EVERY text questions you answer!
Pearl offers a Competitive Compensation and Benefits package to include:
Rate: $18.00 per hour
Additional $4.22 per hour towards Health & Wellness Benefits
Medical, Dental, Vision, and Life Insurance
Paid time off, Paid holidays
Additional ancillary benefits to support your lifestyle professionally, physically, and financially through our professional development and coaching program.
Operating Hours: Monday – Friday, 9 AM – 6 PM (EST) 2 shifts to select from.
Location(s): Arkansas, Louisiana, Mississippi, Texas, Oklahoma, Colorado
Broadband internet connection with a minimum upload speed of 20 Mbps and download speed of 5 Mbps. No Satellite Connections. Test your network at speedtest.com to verify before you apply.
Ethernet cable access. Wi-Fi-only connectivity, prohibited.
Private and secure workspace within your home. Away from noise and distractions.
Computer equipment, monitor(s), and headset provided.
Respond to each customer’s need and request and ensure each customer’s encounter is positive and productive.
Access multiple systems to research customer problems and record inquiry types.
Research CMS and company websites to provide knowledge and education to customers on additional resources which can be used in the future.
Access the IVR and Internet Portal systems as needed to help educate customers on self-service options that are available to them.
Review claims processing systems to identify specific claim edits and audits applied on claims. Analyze claim edits and audits to determine reasons for claim denials.
Review debt recovery systems to troubleshoot reasons for pending accounts receivables and the generation of overpayment demand letters. Review and analyze data to determine reasons for overpayments.
Review local medical coverage and national medical coverage policies in order to troubleshoot reasons for claim denials and reductions.
Review other systems to address and determine a resolution to other customer issues to include pending appeals, aged claims, and Medicare Secondary Payer.
High School diploma, GED, or equivalent. Some college education is preferred.
Minimum 1-year experience in a call center, customer focus, or claims processing in the insurance industry or medical coding, preferred.
Strong problem solving and decision-making skills
Good listening and strong verbal communication skills
Working on a PC in a Windows or similar environment.
The above statements are intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. Pearl management reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Background/Suitability Check, Drug Screening, and Skills Assessments Required
Consistent with E.O. 14042, absent a legally required accommodation relating to a disability, including medical condition, or a sincerely held religious belief, employees must be fully vaccinated for COVID-19 as a condition of employment. This means a COVID-19 vaccination is a qualification standard for the job related to safety for all employees assigned to work on a covered contract.
Skills/Qualifications/Keywords: Action Oriented/Tenacity, Dealing with Ambiguity, Compassion, Customer Focus, Ethics and Values, Functional and Technical Skills, Informing, Integrity and Trust, Listening, Priority Setting, Problem Solving, MS Outlook, and Office Skills, Leadership Team, People Skills, Diversity, Professionalism, Organization, Team Oriented, Learning, Flexibility, Effective Communication.
Pearl Interactive Network, Inc. is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, veteran status, disability status, genetics, or sexual orientation, and gender identity.
To apply for this job please visit pin.hrmdirect.com.