Healthcare Customer Service Specialist II

Job not on LinkedIn

🔥 0 minutes 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 Insurance

🤖 Artificial Intelligence

☁️ SaaS

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

Healthcare Insurance • Artificial Intelligence • SaaS

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

• Work within a team as the primary point of contact for all providers, Medicare contractors, etc. • Provide professional, accurate and timely responses to CMS (Medicare) and provider inquiries. • 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 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 as necessary. • 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, and suggestions to improve or correct processes or documents. • Perform miscellaneous duties as assigned in a highly professional manner.

🎯 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 regardless of 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 at will.