HCS Customer Service Specialist II (SCA)

ABOUT MACHINIFY:In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY:Expected Hiring Range: $19.00 per hourAs a Healthcare Customer Service Specialist II (SCA) you will work within a team and be the primary point of contact for all providers, Medicare contractors, etc. This position provides professional, accurate and timely responses to CMS (Medicare) and provider inquiries. This includes responding to written, telephonic, and electronic inquiries within the appropriate timeframes.Key Responsibilities: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 departmentNotify management of:all escalated displeasure with the audit programlegal actiongovernment interventionescalated concerns regarding audit issues and edit parameters.suggestions to improve or correct processes or documents.Perform miscellaneous duties as assigned in a highly professional manner.Knowledge, Skills, and Abilities Needed:Excellent verbal and written communication skillsSkilled in data entry and knowledge of computersWorking knowledge of ExcelCourteous, professional, and respectful attitudeStrong understanding of customer service policies and processesAbility to learn CMS rules and regulations and understand the CMS Recovery Audit Contractor program.Healthcare and insurance terminology knowledge preferred but not required.Flexibility to prioritize and handle non-standard situations that may arise.Must be detailed, organized and able to manage various job duties as required.Maintain a strong work ethic and attendance.Required and Preferred Qualifications:At least two (2) years’ experience in a call center or customer service position required.At least one (1) year claims processing/billing experience preferred.High School diploma or GED is required.Must maintain HIPAA Certification.WHAT WE OFFER:Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.Physical Requirements & Additional Notices:If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee’s responsibility to maintain this Internet access at their home office location.The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).Regularly sit/stand 8 or more hours per day.Occasionally lift/carry/push/pull up to 10lbs.Machinify is a government contractor and sub