PHRN-Customer Service Representative - PASAY Site

Job Track Description:

Performs tasks based on established procedures.Uses data organizing and coordination skills to perform business support or technical work.Requires vocational training, certifications, licensures, or equivalent experience.

General Profile

Has advanced, specialized expertise within a range of analytical or operational processes.Completes assignments and facilitates the work of others.May coordinate assignments beyond work area.Proposes improvements to processes and methods.Acts as a lead, coordinating the work of others, but is not a supervisor.Works autonomously within established procedures.

Functional Knowledge

Has developed skills in a range of processes, procedures, and systems.Acts as a technical expert in some areas.

Business Expertise

Understanding of how best teams integrate and work together to support the achievement of company goals.

Impact

Impacts a team, by example, through the quality service and information provided.Suggests improvements to work procedures and practices to improve efficiency.

Leadership

Serves as a team lead.May allocate work to team members.Provides subject matter guidance to junior team members.

Problem Solving

Provides solutions to atypical problems with little or no precedent.

Interpersonal Skills

Exchanges information and ideas effectively.Uses tact and diplomacy when dealing with others.

Responsibility Statements

Applies expertise in technical areas when reviewing medical bills such as

high-level office visits, consultations, surgery, appeals, probate, and legal fees.

Establishes appropriate final reimbursement outcomes by distinguishing between Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction.Communicates and upholds the basis for the methodology used to accomplish the reduction of charges.Analyzes and reviews high-level office visits, reports, and record reviews.Interprets hospital review guidelines for both inpatient and outpatient claims.Conducts test studies for the compliance team, requiring high-quality results and strict deadlines.Guides team in training and individual support for new hires.Performs other duties as assigned.Complies with all policies and standards.

A Business Process Services PioneerAs one of the original pioneers in business process outsourcing (BPO) and a leader today, Conduent has deep and diversified expertise across a range of industries and business process solutions.  We help businesses and governments drive process efficiencies, costs savings and long-term revenue growth. Our understanding of our clients’ operations enables us to provide essential services to millions of people every day. Whether it’s helping to reduce ER visits by 25%, driving 99% customer satisfaction, delivering $150B in child support payments or reducing traffic congestion by 15%, Conduent’s services and solutions positively impact the lives of millions of people every day.