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Full Time

Managed Care Customer Service Rep

GENERAL JOB SUMMARY: The Managed Care Customer Service Representative(MCCSR) is responsible for providing Customer Service support by answering incoming phone calls, responding appropriately to patient requests/inquiries regarding insurance claims, insurance balances, and patient balances. Assist clinic staff with eligibility and benefit requests. This may include initiating an action to the patient or insurance carrier. Based on business requirements, the MCCSR will be expected to occasionally perform other duties as assigned by the Supervisor.

Work Hours:

WORK HOURS: The normal work-week is 35-40 hours/week full-time, Monday through Friday as scheduled. Occasional overtime or variations (including evenings and Saturdays) may be required or authorized.


Education & Training:


  • High school graduate or equivalent (minimum)
  • 2 years applicable work experience; or applicable business or medical training and six months applicable experience
  • Basic skills using routine office equipment: computer, copier, fax, and telephone
  • Strong customer service skills
  • Call Center experience preferred

Essential Knowledge, Skills & Abilities:


  • Must possess excellent customer service skills
  • Must be organized, detail oriented and able to adapt quickly to stressful, fast paced work environment
  • Must be able to work in team environment, as well as independently
  • Must be able to communicate effectively in English (grammar, spelling, writing, and verbal skills)
  • Must possess effective reasoning and deductive ability
  • Must be able to read, correctly interpret and follow written guidelines/protocols
  • Must be able to learn and apply new skills
  • Must maintain confidentiality when dealing with medical information
  • Basic knowledge of private and managed care insurance required
  • Basic knowledge of CPT and ICD10 codes required
  • Knowledge of medical terminology, its spelling and abbreviations required
  • Medical software experience preferred; current TMC medical software experience preferred
  • Good computer and keyboarding skills: Microsoft Word required; Excel and Outlook preferred
  • Ability to communicate in Spanish helpful

Essential Job Functions & Duties:



  1. Pulls, photocopies, organizes records and faxes or e-mails as requested
  2. Scans documents into Whiteboard as requested by staff
  3. Performs returned-mail patient statement process
  4. Pre-stuffs envelopes for manually printed statements and other correspondence
  5. Prints, folds, and stuffs letters or statements as needed 


  1. Be “first responder” on incoming customer service calls and clinic “8555” calls
  2. Answers all incoming calls in a timely manner
  3. Creates comprehensive encounter notes to document calls and actions taken on customer account
  4. Initiates appropriate action in response to patient request
  5. Provides support to Clinic staff by verifying eligibility and benefits
  6. Provides all pertinent information to staff when transferring customer requests
  7. Follows established steps prior to transfer of any call
  8. Adds appropriate adjustment or transfers transactions to patient account



  1. Works with TMC staff to resolve recurring problems with claims or patient accounts
  2. Creates all refund tasks as needed according to established process
  3. Accepts patient credit card payments, with appropriate documentation noted for each payment
  4. Establishes Recurring Credit Card Payments for patients according to established procedure
  5. Completes outbound calls to patients on the Courtesy Call List as needed so as not to impede from taking inbound calls


  1. Completes Red Edits as assigned
  2. Immediately notifies supervisor of any delays, missing days, and recurring issues with red edits
  3. Documents actions taken to clear edits and informs supervisor of recurring trends
  4. Completes edit error management claims in clearinghouse and maintains established timeliness criteria


  1. Assists MCAs with return mail as needed to ensure timely completion each week


    1. Interacts with staff members professionally
    2. Follows company policies and procedures (time and attendance, appropriate attire, etc)
    3. Correctly uses office equipment and time clock
    4. Works safely
    5. Other duties as assigned
    6. Meets Performance Measurements added to this job description
    7. Follows the MCCSR Code of Conduct added to this job description


    1. Answer all incoming phone calls made to the main Billing line or 8555 extension.
    2. Answer questions from internal and external customers in a professional manner
    3. Respond to requests from internal and external customers in a professional manner
    4. Meets the service expectations of patients
    5. Resolves problems identified by patients
    6. Meets the service expectations of internal customers
    7. Resolves problems identified by internal customers
    8. Meets the service expectations by external customers
    9. Resolves problems identified by external customers
    10. Follows through on commitments
    11. Interacts with co-workers in other departments in a manner that promotes teamwork and facilitates company goals

Working Conditions & Risks:

WORKING CONDITIONS AND RISKS: Work is indoors in a well lighted, and seasonally heated and cooled business office. Job hazards are estimated to be minimal (low risk). Potential risk exists from accidents while using routine office equipment.

Physical Requirements:

PHYSICAL REQUIREMENTS: Position requires occasional need to lift heavy (30-50lbs) boxes from chest height to floor to chest height. Prolonged sitting, sorting, moving about, and intermittent typing approximately

4-6 hours per day routinely. Good vision, good hearing, and clear speech required (correctable). Repetitive motions consist of extended periods of upper body and upper limb movements (arms, hands, and wrists). Prolonged use of phone and computer.

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