The Customer Service Rep - CHRG assists with held revenue by collecting required documentation, communicating with customers, and applying payer medical policy knowledge in alignment with standard operating procedures.

Identifies opportunities that enhance operational efficiency and improve overall results

JOB FUNCTIONS

Assists with held revenue by obtaining, reviewing, and validating required documentation to support claim resolution
Communicates with customers, payers, and internal teams to gather information, clarify requirements, and resolve outstanding issues
Applies knowledge of payer medical policies, coverage criteria, and reimbursement guidelines to ensure accurate claim processing
Follows established standard operating procedures to maintain compliance, consistency, and quality in all workflows
Monitors accounts for delays, missing documentation, or policy-related barriers and takes proactive steps to resolve them
Identifies trends, gaps, or recurring issues that impact revenue flow and escalates or recommends solutions as appropriate
Collaborates with team members to streamline processes, enhances operational efficiency, and improve overall performance results
Maintains accurate records, notes, and documentation within company systems to support audit readiness and transparency
Meets productivity, quality, and turnaround time expectations as defined by departmental standards
Participates in training, policy updates, and continuous improvement initiatives to stay current with payer requirements and internal processes

Qualifications

Education

High School Diploma or General Education Degree (GED), Required

Work Experience

1 year or more in held revenue, accounts receivable, medical billing, or related healthcare reimbursement functions, preferred
healthcare industry, durable medical equipment (DME), or insurance verification is a plus

Knowledge, Skills, and Abilities

payer requirements, medical policies, and coverage guidelines, preferred
Proficiency with Microsoft Excel and Word, including data entry, documentation management, and basic reporting
Strong attention to detail to analyze account information and identify discrepancies
Effective written and verbal communication for interacting with customers, payers, and internal teams
manage multiple tasks, prioritize workload, and meet productivity and quality expectations
Comfortable working in a fast paced, process driven environment with evolving payer requirements
This position requires use of your own equipment
- Internet Service Type: Cable or Broadband
- Network Firewall on the Internet Connection
- Connection Type: Wired to ISP Modem
- Latency to Florida or Tennessee Data Centers / Ping: < 30ms
- Download Speed: Minimum 80 Mbps
- Upload Speed: Minimum 10 Mbps
- Monitor Size: Minimum 20" Dual Monitors
- Processor Speed: Minimum 1.5 GHz -- Preferred 2.0 GHz
- Main Memory (RAM): Minimum 8GB
- Free Disk Space: Minimum 1GB
- Keyboard: Wired (Wireless not supported)
- Mouse: Wired (Wireless not supported)
- Audio: USB Headset (Bluetooth/AUX not supported)
- Network Connector: Wired Ethernet
- Webcam
- OS Version: Windows 11 (Other OS like ChromeOS/Linux/MacOS not supported)
- OS Update: Automatic
- Antivirus: Automatic updates, always scan mode
- Windows Firewall (Enabled)
- Supported Browsers: Chrome, Edge (Preferred)
- HIPAA compliant workspace (Room with a door)
- Functional work surface (Desk) and chair
- Distraction-free environment

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