Customer Service Manager - Federal Health (CMS)

Commence is focused on data-centric transformation in healthcare, aiming to improve health outcomes through efficient processes. The Customer Service Manager oversees the provider-facing customer service operation, managing a team that addresses provider inquiries and ensuring compliance with response timeframes.

Responsibilities:

• Manage the day-to-day operations of the SMRC provider customer service unit, ensuring the provider phone line is staffed and fully operational from 8:30 AM to 6:00 PM ET on all required business days without interruption
• Oversee all provider inquiry response activities, including phone calls, written correspondence, and portal-based communications; ensure responses are accurate, professionally delivered, and completed within contractually required timeframes
• Handle provider inquiries related to Additional Documentation Request (ADR) letters, medical review determinations, Discussion and Education (D&E) session scheduling, and Medicare appeals processes; ensure staff are trained and equipped to address each inquiry type accurately
• Supervise, train, and performance-manage customer service staff, including scheduling to maintain full coverage during expanded operational hours; develop and maintain staff training materials on SMRC program requirements and Medicare provider communication standards
• Identify, document, and escalate unresolved or complex provider issues to the Project Manager with recommended dispositions; maintain a log of escalated inquiries and track resolution through closure
• Track and report on customer service performance metrics, including call volume, response timeliness, resolution rates, and service level compliance; provide regular reporting to the PM and flag SLA risks before they become contractual issues
• Coordinate with the Medical Review Manager and clinical team to ensure customer service staff have current, accurate information on active review topics, ADR requirements, and program updates to communicate to providers

Requirements:

• Bachelor's degree in Business, Healthcare Administration, Communications, or a related field required. In lieu of a degree, 4 additional years of directly related work experience may be substituted
• Minimum 2 years of experience managing a customer service unit, including direct supervision of staff, scheduling, and performance accountability
• Experience handling Medicare provider inquiries preferred; working knowledge of Medicare billing, claims, or coverage topics that providers commonly raise is a strong asset in this role
• Prior customer service management experience at a CMS contractor, including a Medicare Administrative Contractor (MAC), BFCC-QIO, RAC, SMRC, or similar program with direct provider-facing responsibility
• Experience managing call center or provider relations teams operating under strict Service Level Agreement (SLA) requirements, including documented accountability for response timeliness and quality metrics
• Familiarity with Medicare provider communications standards, including ADR letter requirements, review determination notice procedures, Discussion and Education (D&E) processes, and the Medicare administrative appeal process through the ALJ level