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. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs. 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. Key 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. Knowledge, Skills, and Abilities Needed : 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. Healthcare and insurance terminology knowledge preferred but not required. 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. Required and Preferred Qualifications : 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. Equal Employment Opportunity at Machinify We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/