Healthcare Customer Service Specialist II (SCA)

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.