Healthcare Customer Service Specialist II (SCA)

Performant•San Angelo, TX

1d•$19•Hybrid

About The Position

As a Healthcare Customer Service Specialist II (SCA) you will work within a team and be the primary point of contact for all providers, Medicare contractors, etc. This position provides professional, accurate and timely responses to CMS (Medicare) and provider inquiries. This includes responding to written, telephonic, and electronic inquiries within the appropriate timeframes.

Requirements

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 two (2) years’ experience in a call center or customer service position required.
High School diploma or GED is required.
Must maintain HIPAA Certification.
If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required
Proof of such may be required prior to an offer being made.
It is the Employee’s responsibility to maintain this Internet access at their home office location.
Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).
Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.
Some positions may require the total absence of felony and/or misdemeanor convictions.
Must not appear on any state/federal debarment or exclusion lists.
Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

Nice To Haves

Healthcare and insurance terminology knowledge preferred but not required.
At least one year claims processing/billing experience preferred.

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.

Benefits

Machinify offers a wide range of benefits to help support a healthy work/life balance.
These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.

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