About this role
Role Overview
- Provide professional, accurate and timely responses to CMS (Medicare) and provider inquiries.
- Maintain a current knowledge of all contract requirements and objectives.
- Develop professional working relationships with colleagues, healthcare providers and other Medicare contractors.
- Take inbound calls from providers to answer questions and resolve complex issues.
- Make outbound calls to healthcare providers to confirm if letters requesting records for review have been received.
- Respond to assigned written communications from providers timely and accurately.
- Educate providers on proper process protocols and their appeal rights.
- Establish appropriate contacts and perform necessary research to validate provider contact information.
- Enter and update all contact and activity information into tracking logs and the audit platform.
- Research and route internal/external communications to the appropriate person or department.
- Notify management of escalated displeasure, legal action, government intervention, or suggestions for process improvements.
Requirements
- At least two (2) years’ experience in a call center or customer service position required.
- At least one (1) year claims processing/billing experience preferred.
- High School diploma or GED is required.
- Must maintain HIPAA Certification.
Benefits
- medical
- dental
- vision
- HSA/FSA options
- life insurance coverage
- 401(k) savings plans
- family/parental leave
- paid holidays
- paid time off annually