HCS Customer Service Specialist II (SCA)

About Machinify Machinify is a leading healthcare intelligence company focused on payment and data integration across health plans, serving over 75 plans and 170 million lives. About the Opportunity Hiring Range: $19.00 per hour Position: Healthcare Customer Service Specialist II (SCA) You will serve as primary contact for providers, Medicare contractors, and other stakeholders, delivering accurate and timely responses to CMS and provider inquiries via written, telephonic, and electronic communication. Key Responsibilities Maintain knowledge of contract requirements and objectives. Build professional relationships with healthcare providers and contractors. Handle inbound calls, resolving complex provider issues. Make outbound courtesy calls to confirm receipt of record request letters. Respond promptly and accurately to provider written communications. Educate providers on process protocols and appeal rights. Validate provider contact information through appropriate research. Conduct critical due diligence follow‑ups to resolve inquiries. Enter and update contact and activity information in tracking logs and audit platform. Route internal/external communications to appropriate personnel or departments. Notify management of: escalated concerns regarding audit programs, legal action, government intervention, audit issue parameters, and process or document improvement suggestions. Perform miscellaneous duties as assigned with professionalism. Knowledge, Skills, and Abilities Excellent verbal and written communication skills. Proficient in data entry and computer use. Working knowledge of Excel. Courteous, professional, and respectful demeanor. Strong understanding of customer service policies and processes. Ability to learn CMS rules, regulations, and the CMS Recovery Audit Contractor program. Healthcare and insurance terminology knowledge preferred. Flexibility to prioritize and handle non‑standard situations. Detail‑oriented, organized, and able to manage multiple job duties. Strong work ethic and reliable attendance. Required and Preferred Qualifications Minimum of 2 years in a call center or customer service role (required). At least 1 year of claims processing or billing experience (preferred). High School diploma or GED (required). HIPAA certification required. Benefits Medical, dental, vision, HSA/FSA options, life insurance coverage. 401(k) savings plan. Family and parental leave. Paid holidays and annual vacation time. Physical Requirements & Additional Notices Regularly sit at a desk, use office phone or headset, and work at a computer for 8+ hours per day. Occasional lifting or carrying of up to 10 pounds. For hybrid or remote work, reliable secure high‑speed internet at home office is required. Compliance Requirements Pass pre‑hire criminal background check and drug test. Maintain clearances and comply with drug testing as required. Submit to and complete Machinify Teleworker Agreement upon hire. All employees must report violations of confidentiality and data integrity. Equal Employment Opportunity Statement Machinify is committed to a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, disability, genetic characteristics, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. Third‑party recruitment agency submissions are not accepted unless explicitly agreed to in writing. #J-18808-Ljbffr Machinify