Customer Service Ops Support Specialist

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Manage EOB requests in the Document Manager Inbox.

• Make outgoing calls to billing providers to obtain bills and medical records.

• Address claim messages for all carriers.

• Handle inquiries in the CSBilling and CSIntake mailboxes on a daily basis.

• Distribute daily notifications for workers' compensation hospitals.

• Complete the daily FROI report and submit it to WCMC by 2 p.m.

• Research and disseminate Requests for Precertification (RFP Inbox).

• Process Allstate NIS/Precert requests.

• Enter and distribute FROIs as assigned.

• Input new intake/referrals into the system.

• Inform the Customer Services/Intake Supervisor about activities and any issues that arise.

• Utilize department trackers to monitor daily productivity.

• Log in as a new user to CCS to serve as a backup phone agent.

• Provide backup distribution for the FROI mailbox and assist with Q&A.

• Update the PE List and Employer Manager as necessary.

• Maintain the FROI Right Fax address book.

• Assist with training new staff.

• Carry out additional tasks assigned by the Customer Service/Intake Supervisor.

⛳️ Requirements

• High School Diploma is required.

• At least two years of Customer Service experience is required.

• A College Diploma or completion of Certified Course Work is preferred.

• Experience in Managed Care, Health Care, or in a doctor's office/facility is preferred.

• Understanding of daily customer service operations and principles.

• Familiarity with corporate and departmental policies and procedures.

• Working knowledge of pre-certification, worker’s compensation, group health, PPO lookup, and the Bill Review process.

• Knowledge of various insurance carrier plans.

• Understanding of administrative and clerical procedures and systems.

• Proficiency in the English language, including structure, spelling, composition, and grammar.

• Familiarity with computer hardware and software.

• Knowledge of medical coding, including CPT, ICD-9, and HCPCS codes.

• Proficiency with office equipment such as telephones, computers, fax machines, copy machines, printers, scanners, and calculators.

• Bilingual in Spanish is highly preferred.

• Moderate analytical skills.

• Excellent communication abilities.

• Strong computer and data entry skills.

🏝️ Benefits

• Competitive salary package.

• Health, dental, and vision insurance.

• Opportunities for professional development and training.

• Paid time off and holiday pay.

• Retirement savings plan with company match.