Scheduling Customer Service Representative-PEH

Overview

Location Address: 1010 Spruce Street Espanola, NM

Compensation Pay Range: Minimum Offer $15.64 Maximum Offer $22.56

Now Hiring:
Scheduling Customer Service Representative-PEH

Summary: Responsible for providing customer service for patients in regard to scheduling appointments, referrals, messaging, and maintaining patient demographics. Ensure callers receive service excellence when responding to telephone, written, Pres Online, E-Business, chat, and in person inquiries.

Type of Opportunity: PRN

Job Exempt: No

Job is based: Presbyterian Espanola Hospital

Work Shift: Days (United States of America)

• Responsible for providing customer service for patients in regard to the triage of patients, scheduling appointments, referrals, messaging, and maintaining patient demographics.
• Respond to incoming calls routed through skill-based technology to meet quality standards and performance measurements. Be ready to take calls at the scheduled time, and spend the appropriate amount of time taking calls throughout the shift to resolve contacts on initial encounter. Conduct outbound calls as required and meet established quality/quantity guidelines supporting PHS/PHP/PMG initiatives and/or programs.
• Develop and maintain positive customer or partner relationships. Act as member/patient advocate in dealing with practitioners, employer groups, and brokers. Maintain prescribed standards of quality in all research, customer and partner contacts/service functions and promote customer satisfaction/loyalty through quality contact and timeliness of responses, achieving quality audit results as required.
• Assist in the development of documentation of process and procedures into functional process improvements to enhance overall level of service to customers and partners. Use the Improvement model, identify patterns in call inquiries/grievances, conduct root cause analysis in resubmitted and adjusted claims, and report to management team.
• Research inquiries/special projects as requested and respond to customer, partner or other PHS/PHP business units to ensure accuracy of benefit interpretation with results of research and resolution within required timelines. Responses to customers or partners to be done using Microsoft Word, Excel or similar databases when appropriate. Use available documentation such as D.A.R.T., Provider Manual, Pres Online, and Policies and Procedures to analyze and provide accurate and consistent information and benefit interpretation.
• Participate as an effective and active team member both individually and in a team environment. Participate in a value-added manner as a team member to internal teams as well as other process improvement teams (e.g., QCC) and initiatives.
• Record all calls, mail, email, faxes, walk-in encounters, etc. in appropriate databases to provide meaningful, accurate data for analysis and reporting.
• Assist in coordinating (when necessary) meetings with customers or partners for training, contracting, and reporting.
• Coordinate the encounter or episode process for the customer/patient including scheduling, registration, co-pay collection, financial arrangements, charge posting, and reconciliation of monies collected.

• High school diploma plus one to three years office/business experience. Call center experience preferred and/or claims processing experience preferably in managed care with possible enrollment experience.
• Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff. Written communication skills as well as business writing and presentation skills are required.
• Requires strong organizational skills, ability to create, sort and analyze reports (Excel, Access, etc) and system processes.
• A thorough knowledge of reimbursement methodologies i.e. DRG, Relative Value Systems, Per Diem, Fee schedule, Capitation, etc and some knowledge of risk sharing programs helpful.
• Some knowledge of CRM and EPIC as well as any other databases that may be used PHS Enterprise wide. Demonstrated ability to function effectively as a team member. Requires ability to retain plan details and basic medical terminology. Must be able to work cooperatively with other employees and function under pressure. Demonstrated ability to sustain quality standards. Ability to type 30 wpm with 90% accuracy.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

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