Scheduling Customer Service Representative-PEH

Location: 1010 Spruce Street, Española, NM 87532-2724

Compensation

Pay Range Minimum Offer: $16.42 per hour
Maximum Offer: $26.10 per hour

About the Role

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: Full time
Work Shift: Days

Responsibilities

• 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 resolving contacts on initial encounter.
• Conduct outbound calls as required, meeting 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 to promote customer satisfaction/loyalty.
• Assist in the development of documentation of processes and procedures into functional process improvements to enhance the overall level of service. Use the Improvement model to identify patterns in call inquiries/grievances, conduct root cause analysis, and report to the management team.
• Research inquiries/special projects as requested and respond to customers, partners, or other PHS/PHP business units to ensure accuracy of benefit interpretation within required timelines. Use Microsoft Word, Excel, or similar databases for responses.
• Use available documentation such as D.A.R.T., Provider Manual, Pres Online, and Policies and Procedures to analyze and provide accurate information and benefit interpretation.
• Participate as an effective and active team member both individually and in a team environment. Contribute to internal teams and 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 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.

Requirements

• High school diploma plus one to three years of 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.
• Strong organizational skills, ability to create, sort, and analyze reports (Excel, Access, etc.) and system processes.
• Thorough knowledge of reimbursement methodologies (e.g., DRG, Relative Value Systems, Per Diem, Fee schedule, Capitation) and some knowledge of risk-sharing programs.
• Knowledge of CRM and EPIC, as well as other databases used PHS Enterprise-wide.
• Ability to retain plan details and basic medical terminology.
• Ability to work cooperatively with other employees and function under pressure.
• Ability to sustain quality standards.
• Typing speed of 30 wpm with 90% accuracy.

Benefits

• Comprehensive benefits package including medical, dental, vision, short-term and long-term disability, and group term life insurance.
• Optional voluntary benefits.

Wellness

Presbyterian's Employee Wellness rewards program provides engaging opportunities to enhance health and activate well-being. Earn gift cards and more by participating in wellness activities like challenges, webinars, and preventive screenings.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan, and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees, including more than 1,600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care), and Commercial health plans.