Healthcare Customer Service Specialist II

🕒 5 days ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💝 Customer Support

🚫👨‍🎓 No degree required

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Machinify

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 $10M Series A - Machinify on 2018-10

Healthcare • Consulting • Logistics

Machinify is a healthcare-focused AI platform and services company that reshapes healthcare payments and payment integrity. Its AI operating system unifies claims, medical records, contracts, and policies, and uses foundation models and task-specific agents to automate and improve coding, payment accuracy, recoveries, and cost avoidance. Machinify serves health plans (including 18 of the top 20), supports insourced, hybrid, or fully-managed deployments, and emphasizes measurable outcomes — reporting 85+ customers, 270M member lives covered, and $6B+ in annual cost avoidance and recoveries.

📋 Description

• 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 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.

🎯 Requirements

• 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.

🏖️ Benefits

• Equal Employment Opportunity at Machinify • Participation in E-Verify as required by applicable law • Reasonable accommodation for application process if needed