9 days old

Customer Service Representative

Keystone Peer Review Organization, Inc.
Charleston, WV 25301
  • Job Code

KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.KEPRO is seeking resumes for a highly experienced professional.


  • Answering telephone, screening and directing calls appropriately.

  • Establish a client record for all applicants.

  • Handles and tracks queries from providers and members related to program and service eligibility and resolves issues or refers to appropriate parties for resolution within established timelines.

  • Processes/generates correspondence related to program and service eligibility and prior authorization of services within specified timelines and completes required tracking.

  • Researches, investigates and assists providers to ensure appropriate resolution and tracking of inquiries related to prior authorization status and documents activities per established protocols.

  • Documents and logs inquiry and complaint information within established timelines and protocols.

  • Other duties as assigned to ensure contract deliverables relevant to eligibility are complete and within required timelines. Assist other departments as necessary to meet contract deliverables.


  • Requires High School Diploma or equivalent; (Associates or Bachelors Degree in Human Services Field preferred).

Knowledge, Skills, Abilities


  • General knowledge of office environment and business processes.

  • General knowledge of eligibility verification (Medicaid eligibility and program requirements for specific program of focus preferred).

  • Knowledge of CPT and HCPCS codes preferred.

  • PC proficiency to include Microsoft Office Suite.


  • Excellent verbal and written communication skills.

  • Basic data entry skills.

  • 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.

  • Ability to multi-task.

  • Strong organization skills.

  • Experience with Microsoft programs.


  • 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.


  • Requires minimum 1-2 years in an administrative support or customer service position.

  • Previous experience in the medical office or other medical setting preferred.

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

KEPRO offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements.Only those candidates identified for an interview will be contacted.No Phone Calls Please.Visit our website at www.KEPRO.com for more information on the KEPRO Family of Companies.

EOE AA M/F/Vet/Disability

KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information. 41 CFR 60-1.35(c)

See job description

Posted: 2020-01-08 Expires: 2020-02-06
Sponsored by:
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Sponsored by:
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Customer Service Representative

Keystone Peer Review Organization, Inc.
Charleston, WV 25301

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