Pearl Interactive Network
The Provider Customer Service Representative II 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.
Pearl offers a Competitive Compensation and Benefits package to include:
- Rate: $18.00 per hour + $4.23 per hour towards Health & Wellness Benefits
- Medical, Dental, Vision, and Life Insurance
- Paid time off, Paid holidays
- 401K eligibility
- Learning and Development in a Culture of Caring
- Additional ancillary benefits to support your lifestyle professionally, physically, and financially through our professional development and coaching program.
Operating Hours: Monday – Friday, 9:30 AM – 6:00 PM (EST)
Location(s): Arkansas, Louisiana, Mississippi, Texas, Oklahoma, Colorado
Technical/Equipment Requirements:
- Broadband internet connection with a minimum upload speed of 20Mbps and download speed of 5Mbps. No Satellite Connections. Test your network at speedtest.net to verify before you apply.
- Ethernet cable access. Wi-Fi-only connectivity is prohibited.
- Private and secure workspace within your home. Away from noise and distractions.
- Computer equipment, monitor(s), and headset provided.
Job Duties:
- Respond to needs, and requests, 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 the self-service options available to them.
- Review claims processing systems to identify specific claim edits and audits applied to 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 including pending appeals, aged claims, and Medicare Secondary Payers.
Job Requirements:
- High School diploma, GED, or equivalent. Some college education is preferred.
- Minimum 1-year call center experience in the insurance or medical industry, preferred.
- Current or previous security clearance a plus.
- Strong problem-solving and decision-making skills.
- Good listening and strong verbal communication skills.
- PC in a Windows or similar environment.