HCS Customer Service Specialist II (SCA)
Performant Recovery - San Angelo, TX
posted 3 months ago
About the position
As a Healthcare Customer Service Specialist II (SCA) at Performant, you will play a crucial role in supporting our mission to provide innovative payment accuracy solutions. This position is designed for individuals who are passionate about customer service and are eager to contribute to the healthcare industry. You will be the primary point of contact for healthcare providers, Medicare contractors, and other stakeholders, ensuring that all inquiries are handled professionally and efficiently. Your responsibilities will include responding to a variety of inquiries from providers, including written, telephonic, and electronic communications, all while adhering to strict timelines and maintaining a high level of accuracy in your responses. In this role, you will be expected to maintain a comprehensive understanding of all contract requirements and objectives, which will enable you to develop strong professional relationships with colleagues and healthcare providers. You will take inbound calls to address questions and resolve complex issues, as well as make outbound calls to confirm receipt of important documentation. Educating providers on proper process protocols and their appeal rights will also be a key aspect of your responsibilities. You will need to conduct thorough research to validate provider contact information and perform due diligence follow-ups when necessary. Your ability to enter and update contact and activity information accurately into tracking logs and audit platforms will be essential. You will also be responsible for routing communications to the appropriate departments and notifying management of any escalated issues, legal actions, or suggestions for process improvements. This position requires a detail-oriented individual who can manage various job duties while maintaining a strong work ethic and attendance.
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 to confirm receipt of letters requesting records for review.
- 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.
- Research and route internal/external communications to the appropriate person or department.
- Notify management of escalated displeasure with the audit program, legal action, government intervention, and escalated concerns regarding audit issues.
- 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.
- At least one year claims processing/billing experience preferred.
- 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.
Nice-to-haves
- Healthcare and insurance terminology knowledge preferred but not required.
Benefits
- Medical, dental, and vision coverage options.
- Disability coverage options.
- Life insurance coverage.
- 401(k) savings plans.
- Paid family/parental leave.
- 11 paid holidays per year.
- Sick time and vacation time off annually.
