Customer Service Representative - Hyrbid/One day a week in the Office

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

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.

At Acentra Health, we invest in your skills, offering abundant resources and opportunities for professional development and personal growth. As a rapidly growing national quality improvement and care management organization, we genuinely care about the communities we serve and actively contribute to their well-being. We believe in providing you with the opportunity to excel in your areas of expertise, allowing you to shine at what you do best. Our commitment to continuous learning, development, and fostering career growth ensures that you can reach your full potential and thrive in your professional journey!

Singularly Focused. Mission Driven.

Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.

We do this through our People.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career. Benefits are a key component of your rewards package. Our benefits are designed to provide you additional protection, security, and support for both your career and your life away from work. We offer competitive salaries/pay, fantastic benefits including comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

Customer Service Representative

• Are you an experienced Customer Service Representative looking for a new challenge?
• Do you value care management and quality improvement?
• Are you motivated, energetic, and excited to become part of the Kepro team?

Role Responsibilities

In this role, you will

• Answering incoming telephone calls.
• Resolving customer questions and complaints and requests.
• Adhering to internal policies and procedures.
• Utilizing working knowledge of the organization’s services to meet productivity and quality standards
• Establish a client record for all applicants.
• Handle and track queries from providers and members related to program and service eligibility and resolves issues or refers to appropriate parties for resolution within established timelines.
• Answer telephones, screen and direct calls appropriately.
• Process/generate correspondence related to program and service eligibility and prior authorization of services within specified timelines and completes required tracking.
• Research, investigate and assist providers to ensure appropriate resolution and tracking of inquiries related to prior authorization status and documents activities per established protocols.
• Document and log inquiry and complaint information within established timelines and protocols.
• Please note that this is a Hybrid Role, which entails working in our Charleston, West Virginia office for a minimum of one day per week and remotely for the remaining four day.

Basic Qualifications

To thrive in this role, you should have

• Requires minimum 1 - 2 years in an administrative support or customer service position.
• Previous experience in the medical office or other medical setting preferred.
• Must have ability to effectively communicate with team members and external customers.
• Must have ability to research and resolve issues related to Medicaid program and service eligibility.
• General knowledge of eligibility verification (Medicaid eligibility and program requirements for specific program of focus preferred).
• Knowledge of CPT and HCPCS codes preferred.
• Excellent customer service skills.
• Ability to meet Departmental standards and established workload standards.
• Ability to work well with management and team members to contribute to the achievement of departmental goals.
• Strong organization skills and ability to