Healthcare Customer Service Specialist II (SCA)

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.
• 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 suggest improvements or corrections to processes or documents.

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.
• A high school diploma or GED is required.
• Maintain HIPAA Certification.