Rawlings Group

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 hour

As aHealthcare 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 department

• Notify management of:

  • all escalated 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.

• Perform miscellaneous duties as assigned in a highly professional manner.

Knowledge, Skills, and Abilities Needed:

• Excellent verbal and written communication skills

• Skilled in data entry and knowledge of computers

• Working knowledge of Excel

• Courteous, professional, and respectful attitude

• Strong understanding of customer service policies and processes

• Ability 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 subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further.

Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify 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.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING