Healthcare Customer Service Specialist II

Key Responsibilities

• Maintain 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 to confirm receipt of letters requesting records for review.
• 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.
• Research and route internal/external communications to the appropriate person or department.
• Notify management of escalated displeasure with the audit program, legal action, government intervention, escalated concerns regarding audit issues and edit parameters, and suggestions to improve or correct processes or documents.
• Perform miscellaneous duties as assigned in a highly professional manner.

Knowledge, Skills, and Abilities

• 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.
• Flexibility to prioritize and handle non-standard situations.
• Detailed, organized, and able to manage various job duties.
• 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 required.
• Must maintain HIPAA Certification.