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Healthcare Customer Service Specialist III Lead (SCA)
Job Code:2019-50-4-013
Location:San Angelo, TX
Status:Regular Full Time
The Healthcare Customer Service Specialists (CSS) are the primary points of contact for all providers, Medicare contractors, commercial clients, etc. They respond to all verbal and written inquiries and are responsible for utilizing reports to track inventory and aging.  CSS III are team leads responsible for monitoring and logging CSS I and II quality, providing feedback to team members, providing training to new CSS’s, and maintaining policy and procedure documents for the department.

•Make necessary contacts and/or perform necessary research to validate provider contact information
•Develop professional working relationships with colleagues, healthcare providers and other Medicare contractors. 
•Establish good contacts with providers to assist in gathering documentation and following proper protocols. 
•Enter and update all contact and activity information into the audit platform when appropriate.
•Notify management of: 
all correspondence indicating 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
quality concerns regarding team member performance
•Research and route internal/external communications to the appropriate person or department 
•Handles escalated questions from providers and resolves issues via phone and written correspondence
•Educate providers on their appeal rights 
•Communicate with other staff/departments as necessary 
•Support inventory management by creating outbound courtesy calls lists for team members and manage aging medical records requests.
•Maintain policy and procedure documents as well as contribute to the development and/or improvement of workflows and procedures based upon changing requirements
•Serves as first point of escalation for questions and issues on the team. Use good judgment to inform and/or escalate to management as may be appropriate.
•Perform quality checks and provide feedback to team members
•Provide training and support to new CSS’s as well as all CSS team for any new or changing workflows or requirements
•Maintain a current knowledge of all Medicare rules, regulations, policies and procedures, and contract requirements
•Maintain HIPAA Certification
•Other Duties as assigned
Required Skills and Knowledge:
•Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10 coding
•Ability to communicate professionally both verbally and in written form with internal and external audiences.
•Must have excellent organization skills and attention to detail.
•Highly skilled in data entry with speed, quality and accuracy
•Courteous, professional, and respectful attitude
•Strong understanding of customer service policies and processes
•Provider customer service background
•Possess knowledge of Medicare rules and regulations
•Demonstrated knowledge and skills in medical claims processing and/or billing experience required to perform job duties
•Experience in some capacity of medical claim quality assurance, or past demonstrated experience in a QA function. 
•Strong working proficiency with Microsoft Office suite.  
•Ability to work independently, and work cooperatively within the team, providing strong understanding of workflows, claim escalations, and team training.
•Flexibility to handle any non-standard situations that may arise applying good judgment and decision making skills
•Can meet objectives with minimal supervision.
•Time management skills to effectively manage diverse workload while completing work within allocated time frames in a fast paced dynamic environment.
Education and Experience:

•High school degree or GED required. Some college AS or BS degree is plus.
Minimum 6 years customer service in the medical or health insurance field
•2+ years claims billing and/or Medical claims processing 
•Hospital billing experience preferred

Physical Requirements
Job is in a busy standard office environment with moderate noise level, sits at a desk during scheduled shift, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a mouse. Reads and comprehends information in electronic (computer) or paper form (written/printed).
•Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment
•Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts
•Communicates regularly on the phone.
•Occasionally lift/carry/push/pull up to 10lbs.

Other Requirements

Must submit to and pass background check. Must not have any Federal or State liens resulting from County, State or Federal tax issues.  Must not have any current defaulted student loans.
Must be able to pass a criminal background checks; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment lists.
Must submit to and pass drug screen.
Performant is a government contractor. Certain client assignments for this position may require additional background and/or clearances.

Job Profile is subject to change at any time.

Performant Financial Corporation is an Equal Opportunity Employer. Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.