Healthcare Customer Service Specialist II (SCA)

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. As a Healthcare Customer Service Specialist II (SCA), you will be the primary point of contact for providers and Medicare contractors, providing professional and timely responses to inquiries and ensuring a high level of customer service.

Responsibilities:

• 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 as a courtesy 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
• Conduct critical due diligence follow-ups if additional research or action is required to resolve an inquiry
• Enter and update all contact and activity information into tracking logs and the audit platform where not automatically completed by the system, e.g., a telephone call, correspondence responses, special notes, etc
• Research and route internal/external communications to the appropriate person or department
• Notify management of: all escalated displeasure with the audit program, legal action, government intervention, escalated concerns regarding audit issues and edit parameters, suggestions to improve or correct processes or documents
• Perform miscellaneous duties as assigned in a highly professional manner

Requirements:

• At least two years' experience in a call center or customer service position required
• High School diploma or GED is required
• Must maintain HIPAA Certification
• Excellent verbal and written communication skills
• Skilled in data entry and knowledge of computers
• Working knowledge of Excel
• Courteous, professional, and respectful attitude
• Strong understanding of customer service policies and processes
• Ability to learn CMS rules and regulations and understand the CMS Recovery Audit Contractor program
• Flexibility to prioritize and handle non-standard situations that may arise
• Must be detailed, organized and able to manage various job duties as required
• Maintain a strong work ethic and attendance
• At least one year claims processing/billing experience preferred
• Healthcare and insurance terminology knowledge preferred but not required