Healthcare Customer Service Manager at Provider Network Solutions

Doral, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

30 Aug, 26

Salary

59000.0

Posted On

02 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer Service, Problem Solving, Organizational Skills, Microsoft Word, Microsoft Excel, Adobe Acrobat, Microsoft Outlook, English Fluency, Spanish Fluency, Staff Management, Medical Billing, Medical Coding, Claims Processing, Vendor Relations, SOP Development, EDI Error Resolution

Industry

Hospitals and Health Care

Description

Description Position Summary The Customer Service Manager is responsible for planning, coordinating and controlling the activities of the customer service team to maintain and enhance customer relationships and meet organizational and operational objectives. Supports the customer service team to achieve department goals, according to the department’s Policies and Procedures in a TPA or health plan environment. Duties and Responsibilities • Manage the Customer Service Department to ensure adequate staffing is available to handle call volume and that all agents log in and open the phone system on time. • Monitor call abandonment rates to ensure Health Plan compliance standards are consistently met. • Ensure Customer Service team adherence to PNS policies and procedures regarding eligibility information dissemination to providers. • Serve as the escalation point for resolving complex customer issues, including claim disputes, appeal processes, Health Plan concerns, and provider inquiries. • Train and mentor Customer Service Specialists to ensure high performance, compliance, and service excellence. • Oversee phone system operations and vendor relations (e.g., Nextiva) to maintain reliable communication infrastructure and ensure prompt issue resolution. • Ensure timely completion and submission of monthly phone reports to the Data Integrity team. • Act as liaison alongside Provider Servicing Coordinators to address and resolve issues from Health Plans and Providers. • Collaborate with the Provider Servicing Manager to evaluate and implement quarterly training programs that align with updates in Network, TPA, and healthcare business standards. • Monitor and ensure daily completion of the eligibility workflow, including the resolution of EDI errors related to eligibility review. • Report opening customer service tickets to department heads on Tuesdays and Thursdays, tracking resolution timeliness and accountability. • Supervise daily mailroom operations, including incoming and outgoing correspondence, ensuring compliance with clean desk policies and established procedures. • Supervise the EDI Specialist to ensure timely resolution of daily EDI errors across platforms including QuickCap, QNXT, and SDS. • Oversee additional EDI Specialist responsibilities to ensure department compliance with daily reporting and weekly rejection letter submissions. • Develop, maintain, and update Standard Operating Procedures (SOPs) to promote consistency, operational efficiency, and regulatory compliance across the department. Requirements Knowledge • 3 to 5 years of experience in management/supervisory position required • High school diploma • Knowledge in claims, medical billing, coding and collection required Skills • Proficiency in Microsoft (Word, Excel, Adobe Acrobat, Internet and Outlook). • Fluency in English and Spanish (read, write and speak). • Strong Customer Service, problem solving and organizational skills. • Ability to handle a wide variety of priorities. • Self-starter and able to work independently.

Responsibilities

Manage the customer service team to ensure operational efficiency, staffing adequacy, and compliance with health plan standards. Oversee EDI workflows, resolve complex customer and provider escalations, and develop standard operating procedures.