[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 focused on data-centric transformation in reputed company, aiming to reputed company health reputed company. The Customer Service Manager oversees the provider-facing customer service operation, managing reputed company to ensure accurate and timely responses to 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 each 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 track resolution through closure
• Track and report on customer service performance metrics, including call volume, response timeliness, resolution 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 active 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 direct 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 direct provider-facing responsibility
• Experience managing call center or provider relations teams operating under strict Service Level Agreement (SLA) requirements, including documented accountability for response timeliness and quality 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.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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