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- Charleston, WV
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Customer Service Representative- Enrollment Analyst
Apex Systems • Charleston, WV
Posted 29 days ago
Apex Systems has several openings for an Customer Service Representative to work for our client in the Charleston, WV area. This is a long month contract, if you are interested, please reach out to Lyric Roberts at Lroberts@apexsystems.com
If this is not a great fit for you, please feel free to send the job description to anyone in your network who may be interested
Role: Customer Service Representative
Location: Charleston, WV 25302
You will be responsible for analyzing enrollment inquires and issues using data from internal and external sources to provide insight and make decisions for provider enrollment. Makes recommendations based on business data and market knowledge. Duties may include participating in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. Duties may be internal operations-focused or external client-focused, answering incoming call inquiries, the research and resolution of provider inquiries, and/or disputes concerning the enrollment process. They respond with the answer to all incoming inquiries and coordinate with other departments as needed to resolve the issue, ensuring that resolutions are timely and in compliance with all regulatory requirements.
- Understand the requirements by using document analysis, business process descriptions, cases, business analysis and task and work flow observation.
- Interpret customer business needs and translate them into application and operational requirements
- Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as needed.
- Work with the team within the business to provide recommendations on opportunities for process improvements.
- May actively participate in different stages of project development including research, design, programming, testing and implementation to ensure the released product meets the intended functional and operational requirements
- Resolves and provides a verbal or written response to incoming provider requests relating to their enrollment request and how that affects claim submissions.
- Completes appropriate documentation for tracking/trending data; reviews data to assist with identifying potential provider problem areas.
- Uses a variety of references to research and prepare healthcare provider information for loading into the health plan system/database; enters provider demographics, contract affiliation, or other data as needed.
- Interfaces with other departments regarding questions about provider configuration or other relevant provider issues.
- Maintains tracking system of correspondence and outcomes; maintains well-organized, accurate and complete files for all appeals.
- Monitors each request to ensure all internal and regulatory timelines are met.
- High School diploma or GED equivalent
- 1-2 years’ experience in a managed care or healthcare setting; data entry, and 10-Key experience preferred.
- 1-2 years’ experience with different types of provider license and certification requirements.
Associate's Degree in Business and/or completion of a vocational program in Managed Care or some other health care aspect providing a certificate at completion preferred.
2-3 year’s healthcare experience.
Apex is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at 844-463-6178-6178.