[Remote] Medicare Customer Service Rep

Note: The job is a remote job and is open to candidates in USA. WPS, a health solutions company, is seeking a Medicare Customer Service Rep to provide responses to inquiries from medical providers related to Medicare topics. The role involves educating customers on coverage and claims submission while navigating multiple systems to resolve inquiries accurately and efficiently.

Responsibilities

• Provide responses to provider calls relating to Part A and/or Part B General Inquiries, Part A Appeals Status, Part B Reopening’s, and/or Part A and Part B Provider Enrollment Inquiries
• Assist and educate providers on Medicare regulations on inquiries by utilizing CMS guidelines, publications, and reference materials to ensure correct claim submission
• Enroll providers with recurrent concerns or errors into contact programs for intensive education
• Maintain knowledge of A and/or B processing systems and applications required for job functions, including Multi-Carrier System Desktop (MCSDT), Fiscal Intermediary Shared System (FISS), Common Working File (CWF), CMS Secure Net Access Portal (SNAP), Provider Enrollment Chain and Ownership System (PECOS), OnBase, Medicare Appeals System (MAS,) and Customer Relations Management System (CRM)
• Work with internal and external customers to obtain information required to respond to and ensure consistency in the resolution of inquiry-related issues
• Assist the department in meeting CMS performance and award fee metrics and all quality and quantity standards
• Support other departments within the division as needed, to ensure CMS performance requirements are maintained
• Ensure adherence to regulatory guidelines (i.e., HIPAA, CMS) when providing information and can service to members and providers

Skills

• High School Diploma or GED or equivalent
• 1 or more years of customer service experience working with health insurance and / or Medicare or Durable Medical Equipment Claims
• Ability to function in a fast paced, high volume call center environment
• Proficiency in Microsoft Office Suite and customer service software
• Strong verbal and written communication skills with the ability to effectively explain complex information
• Solid ability to multitask, prioritize, and manage time effectively in a fast-paced environment
• Ability to maintain a high level of accuracy and attention to detail
• 1 or more years of Medicare customer service experience and/or claims processing
• Solid knowledge of Medicare Part A and/or Part B program guidelines
• Solid knowledge of insurance, medical coding and medical terminology

Benefits

• Remote work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs

Company Overview