Scheduling Customer Service Representative-PEH

Responsibilities

• Provide customer service for patients regarding 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.
• Triage patients and conduct outbound calls as required to support PHS/PHP/PMG initiatives and/or programs.
• Develop and maintain positive customer or partner relationships, acting as a member/patient advocate.
• Assist in documenting process and procedures to enhance overall level of service to customers and partners.
• Conduct root cause analysis on resubmitted and adjusted claims and report findings to management team.
• Research inquiries/special projects as requested and respond to customer, partner, or other PHS/PHP business units within required timelines.
• 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, contributing to value-added initiatives.
• Record all calls, mail, email, faxes, walk-in encounters, etc. in appropriate databases for analysis and reporting.
• Coordinate 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.

Qualifications

• 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, physician office staff.
• Written communication skills as well as business writing and presentation skills are required.
• 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.
• 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.

Benefits

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, webinars, preventive screening and more.