Customer Service Manager - Federal Health (CMS)

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. 

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.? 

The Customer Service Manager (CSM) oversees the SMRC’s provider-facing customer service operation, which serves as the primary point of contact for the hundreds of provider calls and written inquiries the program receives daily. The CSM manages the team responsible for handling these contacts, ensures all provider communications are addressed accurately and within contractually required response timeframes, and escalates unresolved or sensitive issues to the Project Manager. This role is the operational face of the SMRC to the Medicare provider community and directly affects provider trust, compliance rates, and the program’s overall reputation with CMS.

Essential Duties and 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 all required business days without interruption.
• Oversee all provider inquiry response activities, including phone calls, written correspondence, and portal-based communications; ensure responses are accurate, professionally delivered, and completed within contractually required timeframes.
• Handle provider inquiries related 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; develop and maintain staff training materials on SMRC program requirements and Medicare provider communication standards.
• Identify, document, and escalate unresolved or complex 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; provide 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 current, accurate information on active review topics, ADR requirements, and program updates to communicate to providers.

Qualifications 

• Bachelor’s degree in Business, Healthcare Administration, Communications, or a related field required. In lieu of a degree, 4 additional years of directly related 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 raise is a strong asset in this role.

Preferred Qualifications

• 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.

Work Environment/Physical Demands 

The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is a remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

Commence is an equal employment opportunity employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law. 

Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or hr@commence.ai. Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.