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
Requirements:
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
- Download Speed: Minimum 80 Mbps
- Upload Speed: Minimum 10 Mbps
- Monitor Size: Minimum 20" Dual Monitors
- Processor Speed: Minimum 1.5 GHz - Preferred 2.0 GHz
- Main Memory (RAM): Minimum 8GB
- Free Disk Space: Minimum 1GB
- Keyboard: Wired (Wireless not supported)
- Mouse: Wired (Wireless not supported)
- Audio: USB Headset (Bluetooth/AUX not supported)
- Network Connector: Wired Ethernet
- Webcam
- OS Version: Windows 11 (Other OS like ChromeOS/Linux/MacOS not supported)
- OS Update: Automatic
- Antivirus: Automatic updates, always scan mode
- Windows Firewall (Enabled)
- Supported Browsers: Chrome, Edge (Preferred)
- HIPAA compliant workspace (Room with a door)
- Functional work surface (Desk) and chair
- Distraction-free environment
