Client Customer Service Representative (Key Account Rep)

Remote $20.00 to $22.00 per hour

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talented individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

You can shine with us in a Key Account Representative position by assisting callers in an engaging and professional manner.

• You will have a steady Monday through Friday 40 hour per week schedule:
  • 8:00 am to 4:30 pm for Eastern, Central and Mountain time zones
  • 7:00 am to 3:30 pm for Pacific time zone
• Earn $20.00 to $23.00 per hour and have the opportunity to receive additional bonuses based on performance.
• We provide an excellent paid classroom training program as well as continuous on the job coaching and mentoring. We also have advancement and growth opportunities available to employees.
• Find more information on what it's like to be a MultiPlan employee on our Careers page at www.multiplan.com

JOB ROLES AND RESPONSIBILITIES

1. Receive communication of a client issue and analyze, research and resolve claim appeals through effective use of provider contract rates and fee schedule reimbursement considering products and contract association. Responsible for all customer service client correspondence including client calls, e-mails, written correspondence and portal. Holds regularly scheduled meetings with their assigned clients to discuss open items, provide status on inventory and resolve all concerns presented by the client.
2. Identify and understand all relevant provider data/client date, provider/client contract provisions, network/sales strategies and claim processes and procedures.
3. Knowledge of provider contract language in order to successfully educate the provider on their contract provisions.
4. Work directly with provider to negotiate successful resolution of issue to ensure no reoccurring appeals for the issue.
5. Reprice or adjust facility and progessional claims or appeals. Responsible for running claim reports to determine the potential impact and reporting large case adjustment to Management.
6. Complete legal review which includes drafting affidavits and contract requests for our WC/Auto clients.
7. Research and respond to questions from clients regarding claims repricing by reviewing client set up, provider rates, provider contract matching through EDI and electronic data transfer.
8. Respond to all client contacts within one business day, in a clear and efficient manner that addresses the material received. Continue client follow up every three days on all open cases and 24 hour follow up on client expedited issues.
9. Meet client SLA's which are identified in the client contract.
10. Provide clear and effective client direction on adjusted claim payments where necessary.
11. Fully update provider profiles as appropriate assuring continual adhearance to established operational guidelines.
12. Identify and categorize trends in client issues and identifies root cause of issues.
13. Maintain department standards for production, accuracy and turnaround time.
14. Operationally assist and communicate with internal departments of all issues, complaints, research, resolution, documentation and communication of customer issues.
15. Research and respond to routine attorney inquiries regarding specific claims or isolated claim appeals ensuring timely and accurate response.
16. Act as a liaison for remote customers and internal claims staff by responding to questions regarding interpretation and reimbursement of facility and physician claims per their contract.
17. Escalate issues that could jeopardize provider/client relationships to management.
18. Monitor case loads and productivity and alert Team Lead and/or Manager when unable to maintain standards.
19. Collaborate, coordinate, and communicate across disciplines and departments.
20. Ensure compliance with HIPAA regulations and requirements.
21. Demonstrate Company's Core Competencies and values held within.
22. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
23. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.