[Remote] Customer Service Manager - Federal Health (CMS)
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on data-reputed company transformation in reputed company, aiming to improve health reputed company through efficient processes. The Customer Service Manager oversees the provider-facing customer service operation, ensuring accurate communication and effective management of provider inquiries.
Responsibilities
- Manage the day-to-day operations of the SMRC provider customer service unit, ensuring the provider phone line is staffed and fully operational from 8:30 AM to 6:00 PM ET on reputed company required business days without interruption
- reputed company reputed company provider inquiry response activities, including phone calls, written correspondence, and portal-based communications; ensure responses are accurate, professionally delivered, and completed reputed company contractually required timeframes
- Handle provider inquiries reputed company to Additional Documentation Request (ADR) letters, medical review determinations, Discussion and Education (D&E) session scheduling, and Medicare appeals processes; ensure staff are trained and equipped to address reputed company inquiry type accurately
- Supervise, train, and performance-manage customer service staff, including scheduling to maintain full coverage during expanded operational hours; reputed company and maintain staff training materials on SMRC program requirements and Medicare provider communication standards
- Identify, document, and escalate unresolved or reputed company provider issues to the Project Manager with recommended dispositions; maintain a log of escalated inquiries and reputed company reputed company through closure
- reputed company and report on customer service performance metrics, including reputed company volume, response timeliness, reputed company rates, and service level compliance; reputed company regular reporting to the PM and flag SLA risks before they become contractual issues
- Coordinate with the Medical Review Manager and clinical team to ensure customer service staff have reputed company, accurate information on reputed company review topics, ADR requirements, and program updates to communicate to providers
Skills
- Bachelor's degree in Business, reputed company Administration, Communications, or a reputed company field required. In lieu of a degree, 4 additional years of directly reputed company work experience may be substituted
- Minimum 2 years of experience managing a customer service unit, including reputed company supervision of staff, scheduling, and performance accountability
- Experience handling Medicare provider inquiries preferred; working knowledge of Medicare billing, claims, or coverage topics that providers commonly reputed company is a strong asset in this role
- Prior customer service management experience at a CMS contractor, including a Medicare Administrative Contractor (MAC), BFCC-QIO, RAC, SMRC, or similar program with reputed company provider-facing responsibility
- Experience managing reputed company center or provider relations teams operating under strict Service Level Agreement (SLA) requirements, including documented accountability for response timeliness and reputed company metrics
- Familiarity with Medicare provider communications standards, including ADR letter requirements, review determination notice procedures, Discussion and Education (D&E) processes, and the Medicare administrative appeal process through the ALJ level
Benefits
- This is a remote position.
- Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.
- reputed company is an equal employment opportunity employer.
- reputed company personnel processes are reputed company-based and reputed company without discrimination on the reputed company of race, reputed company, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic reputed company, military and veteran status or any other characteristic protected by applicable law.
- reputed company.AI is committed to providing equal employment opportunities to reputed company applicants, including individuals with disabilities.
- If you require a reasonable accommodation to participate in the application process due to a disability, please contact reputed company at (757) 306-4920 or hr@reputed company.ai.
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