Healthcare Customer Service Specialist II

📋 Description

• • Serve as the first and most trusted voice for healthcare providers nationwide, acting as the essential bridge between clinicians and the Machinify AI platform that safeguards more than 170 million covered lives.
• • Own every inbound and outbound interaction—phone, email, fax, and secure portal—delivering accurate, empathetic answers within contractual timeframes that can directly affect a provider’s cash-flow and a patient’s continuity of care.
• • Master the nuances of multiple payer contracts, federal audit rules, and Machinify’s proprietary edit logic so you can translate complex policy language into plain-English guidance that a busy practice manager can act on immediately.
• • Investigate and resolve high-stakes inquiries such as missing documentation requests, denied claim reconsiderations, and appeal rights, escalating only when legal action or government intervention is imminent.
• • Conduct proactive courtesy calls to confirm receipt of record-request letters, reducing downstream delays and strengthening provider relationships before friction ever surfaces.
• • Document every touchpoint—calls, emails, research notes, escalations—in our audit platform with forensic precision, ensuring a defensible trail that supports both compliance and continuous process improvement.
• • Partner with clinical auditors, data scientists, and client success managers to feed real-world provider feedback into the next generation of AI edits, directly influencing product enhancements that reach 75+ health plans.
• • Educate providers on proper billing protocols, coding best practices, and their statutory appeal rights, turning each interaction into a mini-training session that reduces future errors and builds long-term trust.
• • Perform critical due-diligence follow-ups—verifying addresses, tax IDs, NPIs, and authorized contacts—to eliminate rework and ensure that sensitive health information reaches the right hands every time.
• • Monitor dashboards and SLAs to prioritize your daily queue, juggling up to 60 complex cases while maintaining an average handle time that respects both provider schedules and company efficiency targets.
• • Flag systemic issues—unclear letters, confusing portal workflows, or ambiguous policy language—to management and the continuous-improvement team, turning frontline pain points into enterprise-level fixes.
• • Maintain HIPAA certification and model best-practice privacy behaviors, treating every provider’s data as if it were your own family member’s PHI.
• • Contribute to a remote-first culture that values candor, curiosity, and customer obsession, joining daily huddles, monthly calibration sessions, and quarterly provider-listening tours to keep your finger on the pulse of the market.
• • Embrace an ever-evolving regulatory landscape—CMS updates, state billing mandates, payer policy bulletins—by completing micro-learning modules and sharing quick-hit knowledge nuggets with teammates in real time.
• • Celebrate wins: every correctly routed appeal, every clarified policy, every provider who ends the call saying “thank you” is a step toward Machinify’s mission of making healthcare payments transparent, accurate, and fair.