Customer Service Representative (Remote within CA)

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Customer Service Representative (remote within CA) to join our growing team.

Job Summary:

The Customer Service Representative will be responsible for supporting the authorization process by:

• Answering incoming telephone calls.
• Resolving customer questions, complaints, and requests.
• Adhering to internal policies and procedures.
• Utilizing working knowledge of the organization’s services to meet productivity and quality standards.
• Ability to complete Treatment Authorization Request (TAR) forms for processing claims.

*Position is remote but candidates must reside within the State of California.

Job Responsibilities:

• Develop and maintain a working knowledge of internal policies, procedures, and services (both departmental and operational).
• Utilize automated systems to log and retrieve information.
• Perform accurate and timely data entry of electronic faxes.
• Receive inquiries from customers or providers by telephone, email, fax, or mail and communicate responses within required turnaround times.
• Respond to telephone inquiries and complaints in a prompt, accurate, and courteous manner, following standard operating procedures.
• Interact with hospitals, physicians, beneficiaries, or other program recipients.
• Investigate and resolve or report customer problems. Identify and escalate difficult situations to the appropriate party.
• Meet or exceed standards for call volume and service level per department guidelines.
• Initiate files by collecting and entering demographic, provider, and procedure information into the system.
• Ability to complete Treatment Authorization Request (TAR) forms for processing claims.
• Serve as liaison between the Review Supervisors and external providers.
• Maintain logs and document the disposition of incoming and outgoing calls.
• Ensure all appeals are handled within the required timeframes and comply with all applicable healthcare laws and regulations.
• Communicate effectively with clients and their families to explain the appeals process, expected timelines, and any required actions on their part.
• Review and process incoming appeals for denied services, ensuring compliance with both internal policies and external regulatory requirements.
• The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Requirements

Required Qualifications/Experience:

• High School diploma OR GED OR equivalent education.
• 2+ years of customer service/telephone experience in a similar call center environment and/or industry.

Preferred Qualifications/Experience:

• Medical terminology course(s).
• Medical billing experience (e.g., Treatment Authorization Request (TAR) forms for processing claims).
• Speak English fluently enough to be clearly understood over the telephone.
• Speak Bilingual Spanish-English fluently enough to be clearly understood over the telephone.
• Use the phone system effectively.
• Research and investigate the Treatment Authorization Request (TAR) form.
• Follow confidentiality policies and procedures.
• Navigate and use electronic equipment and systems easily and proficiently.
• Multitask on a personal computer while conducting telephone conversations.
• Work in a fast-paced call center environment.
• Remain calm and courteous when handling difficult calls and requests.
• Working remotely from home requires you to work in a confidential location, free from distractions.
• Experience working with HIPAA and other healthcare-related privacy regulations.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career.

Thank You!

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is $18-20 per hour.

Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.