Contract Customer Care Specialists

Vaco is hiring several Contract Customer Care Specialists
Location: Miramar, FL
Compensation: $20/hour
Schedule: Monday-Friday 9AM-6PM

Overview:
The Customer Care Specialist plays a critical role in coordinating healthcare services, ensuring timely delivery of approved services and items for patients. This multi-faceted position involves daily interactions with patients, healthcare providers, home health agencies, durable medical equipment (DME) providers, and health plans. The specialist serves as a key liaison, facilitating smooth transitions of care while maintaining compliance with regulatory requirements. Success in this role requires excellent communication, problem-solving, and organizational skills to enhance service delivery and patient satisfaction.

Key duties / responsibilities / accountabilities, and other duties as assigned/required:
Patient & Provider Coordination:

• Act as the primary liaison between patients, providers, and health plans to address and resolve service-related issues.
• Facilitate the timely scheduling and delivery of authorized services, ensuring high-quality patient care.
• Maintain effective communication with providers to ensure compliance with network standards and service expectations.

Customer Service & Issue Resolution:

• Handle inbound calls, chat messages, and emails, providing prompt and professional support.
• Manage customer service calls transferred to the department for resolution.
• Conduct outbound calls to patients and providers to confirm service delivery and resolve any delays.
• Address patient concerns in a courteous, professional, and timely manner.

Referral Management & Documentation:
Ensure all referral documentation is accurate, complete, and properly recorded in relevant systems.
Resolve referral-related issues, including provider availability, authorization delays, and patient escalations.
Assist in identifying providers across regions or markets with the capacity to meet patient needs.
Provider & Health Plan Relations:

• Maintain and strengthen relationships with network providers and health plan partners.
• Support the Provider Network Department in negotiating Letters of Agreement (LOA) or Single Case Agreements (SCA) when necessary.
• Serve as a resource for providers, health plans, and internal staff while supporting the Utilization Management Program.

Compliance & Quality Assurance:

• Ensure confidentiality and compliance with HIPAA, CMS, NCQA, and company policies.
• Participate in performance improvement initiatives, committee meetings, and training activities to support quality improvement efforts.

Claims & Billing Support:

• Investigate claim denials or payment discrepancies related to referral errors, missing authorizations, or incorrect documentation.
• Collaborate with the claims processing team to resolve referral-related issues before adjudication.

General & Administrative Duties:

• Maintain thorough and accurate documentation of patient interactions and service confirmations.
• Escalate service delays or concerns to the appropriate department for resolution.
• Participate in team meetings, training sessions, and after-hours/on-call support as scheduled.
• Perform other duties as assigned to support department operations.

Determining compensation for this role (and others) at Vaco/Highspring depends upon a wide array of factors including but not limited to the individuals skill sets, experience and training, licensure and certifications, office location and other geographic considerations, as well as other business and organizational needs. With that said, as required by local law in geographies that require salary range disclosure, Vaco/Highspring notes the salary range for the role is noted in this job posting. The individual may also be eligible for discretionary bonuses, and can participate in medical, dental, and vision benefits as well as the companys 401(k) retirement plan. Additional disclaimer: Unless otherwise noted in the job description, the position Vaco/Highspring is filing for is occupied. Please note, however, that Vaco/Highspring is regularly asked to provide talent to other organizations. By submitting to this position, you are agreeing to be included in our talent pool for future hiring for similarly qualified positions. Submissions to this position are subject to the use of AI to perform preliminary candidate screenings, focused on ensuring minimum job requirements noted in the position are satisfied. Further assessment of candidates beyond this initial phase within Vaco/Highspring will be otherwise assessed by recruiters and hiring managers. Vaco/Highspring does not have knowledge of the tools used by its clients in making final hiring decisions and cannot opine on their use of AI products.