Customer Service Rep IV
About The Position
The Texas Health and Human Services Commission (HHSC) Medicaid & CHIP Services (MCS) department seeks a highly qualified candidate for a Customer Service Representative in the Provider Claims Services (PCS) unit. This position reports to the PCS Program Supervisor and performs highly advanced customer service work in a call center environment. Work involves contact with Medicaid Long Term Care (LTC) providers, Medicaid recipients, HHSC case workers and eligibility staff regarding filing claims for services and billing issues. The position researches and analyzes complex data within multiple systems to resolve any issues and ensures claims continue to be processed accordingly. The position interprets section policies and procedures for filing claims for services provided under Hospice, Nursing Homes, Intermediate Care Facilities, and various waiver programs including Home and Community-based Services, Texas Home Living, Deaf Blind Multiple Disabilities, and Community Living Assistance and Support Services.
Requirements
- Two years' experience working in a call center or customer service-oriented environment.
- Skill in the use of standard office equipment.
- Skill and experience resolving complicated billing issues promptly and efficiently.
- Experience utilizing Microsoft Office Excel spreadsheets.
- Ability to apply policies and procedures and recommend changes.
- Ability to review problems and recommend solutions.
- Ability to communicate verbally with stake holders.
Nice To Haves
- Preferred experience with Provider Claims Services systems.
- Preferred experience in researching and interpreting Medicaid policies and procedures.
Responsibilities
- Responds to inquiries regarding claims processing and billing issues for Medicaid LTC providers, recipients, agency case workers and eligibility staff via emails, reports, correspondence, or hotline.
- Researches and analyzes data within various automated systems to identify issues with claim processing/billing.
- Documents information in spreadsheets.
- Enters data, supporting records and actions taken to resolve billing or claims processing issues.
- Uses multiple systems including Client Assignment and Registration System (CARE), IDD Portal, Service Authorization System Online (SASO), Texas Medicaid and Health Care Partnership (TMHP) Long Term Care Portal, and a call tracking system.
- Provides training to Medicaid providers on how to address or resolve issues in filing/processing claims.
- Interprets section policies and procedures for processing claims and service authorizations for LTC providers.
- Collaborates with PCS coaches to resolve more complex claims/billing issues or provider concerns.
Benefits
- 100% paid employee health insurance for full-time eligible employees
- A defined benefit pension plan
- Generous time off benefits
- Numerous opportunities for career advancement
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
