Customer Service Rep 3 - 00205766 RTF (BF)

Pay Grade: H

The Georgia Department of Community Health (DCH) is one of Georgia's four health agencies serving the state's growing population of over 10 million people. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (SHBP) and Healthcare Facility Regulation, impacting one in four Georgians.

Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and under-served populations.Six enterprise offices support the work of the agency’s three program divisions. DCH employees are based in Atlanta, Cordele and across the state.

DCH is committed to providing superior Customer Service and Communication, embracing Teamwork and fostering Accountability to ensure that our internal and external customers and stakeholders feel included, respected, engaged and secure.

Job Description:
Under the supervision of the Manager of Provider Enrollment, the Customer Service Representative 3 reviews, monitors and ensures compliance with Medicaid policies and procedures. Provides technical and customer support, reviews enrollment applications, updates enrollment files and is a point of communication with professionals and groups related to programs in area of assignment.

Job Responsibilities & Performance Standards:

1. Receives and responds to written and verbal inquiry related to Medicaid eligibility regulations and procedures.Communicates with clients (e.g.) Providers, Billing Agents, credentialing coordinators, office staff, et al) and obtains all required information necessary to determine and address their specific needs; tactfully explains why, if service cannot be provided and appropriate refer to the correct department. Conducts thorough research of relevant materials and resources as necessary. Responds to client disseminating accurate information in the manner and timeframe promised or follows-up to explain status.Documents research and responses in a clear, concise and timely manner.Drafts appropriate correspondence as necessary
2. Recommends modifications to and identifies problems with MMIS Programs.Clearly and effectively communicates necessary systems modifications to appropriate systems staff in a timely manner.Demonstrates an understanding of MMIS programs and refers appropriate problems to staff for resolution.Utilizes various software programs to document system defects.
3. Ensures timely processing of applications.Responds to each application for enrollment inquiry in a timely manner Reviews and evaluates application content to ensure compliance with department and program standards. Reviews enrollment applications for completeness and correctness. Returns incomplete applications for additional information or contacts the provider to obtain the necessary documentation. Routes to appropriate personnel for verification and approval of enrollment. Reviews and completes provider request for retroactive enrollment based on the Departments policy guidelines.
Additional:

We are seeking a detail-oriented Credentialing Specialist to manage the end-to-end credentialing and recredentialing processes for our healthcare providers. The ideal candidate will ensure that all providers meet licensing, certification, and regulatory standards.

High school diploma/GED and three (3) years of experience in a customer service setting communicating information; or two (2) years of experience required at the lower-level Customer Svc Rep 2 (GST121).

EARN MORE THAN A SALARY! In addition to a competitive salary, the Georgia Department of Community Health offers a generous benefits package, which includes employee retirement plan; paid holidays annually; vacation and sick leave; health, dental, vision, legal, disability, accidental death and dismemberment, health and child care spending account.

Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered, but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification.

THIS POSITION IS SUBJECT TO CLOSE AT ANY TIME ONCE A SATISFACTORY APPLICANT POOL HAS BEEN IDENTIFIED. APPLICATIONS WITHOUT WORK EXPERIENCE LISTED WILL NOT BE CONSIDERED. CURRENT GEORGIA STATE GOVERNMENT EMPLOYEES WILL BE SUBJECT TO STATE PERSONNEL BOARD (SPB) RULE PROVISIONS. THE POSITION MAY BE FILLED AT A LOWER OR HIGHER POSITION LEVEL.

This position is unclassified and employment is at-will. Candidates for this position are subject to

a background history, reference check, and credit check. For more information about this job

contact: : http://dch.ga.gov