Customer Service Representative (Remote Opportunity) at Keystone Peer Review Organization, Inc. in Richmond, Virginia

Job Description:

KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. KEPRO is seeking resumes for a highly experienced professional.

Customer Service Representative

 

Summary Description 

Responsible for supporting the prior authorization process by answering incoming telephone calls, resolving customer questions, complaints and requests adhering to internal policies and procedures and utilizing working knowledge of the organization’s services to meet productivity and quality standards.  

Accountabilities 

• Develops and maintains working knowledge of internal policies, procedures and services (both departmental and operational).


• Utilizes automated systems to log and retrieve information. Performs accurate and timely data entry of electronic faxes.


• Receives inquiries from customers or providers by telephone, email, fax, or mail and communicates response within required turnaround times.


• Responds to telephone inquiries and complaints in a prompt, accurate, and courteous manner following standard operating procedures.


• Interacts with hospitals, physicians, beneficiaries, or other program recipients.


• Investigates and resolves or reports customer problems. Identifies and escalates difficult situations to the appropriate party.


• Meets or exceeds standards for call volume and service level per department guidelines.


• Initiates files by collecting and entering demographic, provider and procedure information into the system.


• Serves as liaison between the Review Supervisors and external providers.


• Maintains logs and documents disposition of incoming and outgoing calls.

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. 

Qualifications 

• High School diploma or equivalent.


• Medical terminology course(s) helpful.

Knowledge, Skills, Abilities 

• Knowledge of:
  
  
  
  • Medical terminology
  
  
  • Health insurance industry
  
  
  
  


• Ability to:
  
  
  
  • Speak English fluently enough to be clearly understood over the telephone.
  
  
  • Use phone system effectively.
  
  
  • Research and investigate.
  
  
  • 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 request
  
  
  
  


• Skills:
  
  
  
  • Bilingual Spanish-English a plus.
  
  
  • Effective verbal and listening skills to provide courteous and professional customer service.
  
  
  • Effective PC skills including, electronic mail, intranet and industry standard applications.
  
  
  
  

Experience 

• 2+ year’s customer service/telephone experience in a similar call center environment and/or industry.

Mental and Physical Requirements               

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

KEPRO offers challenging careers, excellent benefits and opportunities for advancement.  For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please.  Visit our website at www.KEPRO.com for more information on the KEPRO Family of Companies.   

EOE AA M/F/Vet/Disability

KEPRO is and 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, or status as a protected veteran.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

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