Healthcare Customer Service Specialist II

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate within a team as the main point of contact for all providers, Medicare contractors, and others.

• Deliver professional, precise, and timely responses to inquiries from CMS (Medicare) and providers.

• Keep up-to-date knowledge of all contract requirements and objectives.

• Foster professional relationships with colleagues, healthcare providers, and other Medicare contractors.

• Handle inbound calls from providers to address questions and resolve complex issues.

• Initiate outbound calls to healthcare providers to verify the receipt of letters requesting records for review.

• Respond promptly and accurately to assigned written communications from providers.

• Educate providers on the correct process protocols and their rights to appeal.

• Identify appropriate contacts and conduct necessary research to confirm provider contact information.

• Execute critical due diligence follow-ups if additional research or action is required to resolve an inquiry.

• Record and update all contact and activity information in tracking logs and the audit platform as needed.

• Research and direct internal/external communications to the relevant person or department.

• Inform management of any escalated dissatisfaction with the audit program, legal actions, government interventions, escalated concerns regarding audit issues and edit parameters, as well as suggestions for improving or correcting processes or documents.

• Perform various duties as assigned in a highly professional manner.

⛳️ Requirements

• Minimum of two years’ experience in a call center or customer service role is required.

• Preferred: at least one year of claims processing/billing experience.

• A High School diploma or GED is mandatory.

• Must hold HIPAA Certification.

🏝️ Benefits

• Equal employment opportunity without regard to race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status.

• Proud to be an equal opportunity workplace.

• Employment is at will.