Call Center Representative-Health Plan-Work from home

Overview

Presbyterian Healthcare is seeking a Call Center Representative to provide exceptional customer service for Health Plan members. This work-from-home role requires candidates to be located in the metro Albuquerque, NM area.

 

Key Responsibilities:

• Respond to patient inquiries via phone, written correspondence, Pres Online, E-Business, chat, and in-person
• Assist with scheduling appointments, referrals, messaging, and updating patient demographics
• Ensure service excellence and a positive member experience in every interaction
• Maintain accurate records and documentation in compliance with policies

We're determined to take care of those working in healthcare.

Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

 

Why Join Us:

• Full Time - Exempt: No
• Job is based Rev Hugh Cooper Admin Center
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:

• Strong communication and customer service skills
• Ability to navigate multiple systems and respond efficiently to inquiries
• Committed to delivering high-quality support for patients and the Health Plan

Qualifications

• High school diploma plus one to three years office/business experience; call center experience preferred and/or is currently demonstrating customer service skills, meeting current department metric and attendance guidelines within department.
• Claims processing experience in managed care with possible enrollment experience is preferred.
• 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 Facets, 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. Must be able to prove ability to type 30 wpm with 90% accuracy.

Responsibilities

• Responds to questions or issues from PHP members and providers about insurance benefits, coverage, or premiums (Medicaid, Commercial, IBAC, Medicare) with regard to: eligibility and demographic changes; ID card request and issuance; PCP assignments and changes; eligibility, terms and conditions, with respective benefit plan.
• Respond to incoming calls routed through skill-based technology to meet quality standards and performance measurements. Is ready to take calls at the scheduled time, and spends the appropriate amount of time taking calls throughout their shift to resolve contacts on initial encounter. Conducts outbound calls as required and meets established quality/quantity guidelines supporting PHS/PHP/PMG initiatives and/or programs.
• Develop and maintain positive customer or partner relationships. Acts as member/patient advocate in dealing with practitioners, employer groups, and brokers. Maintains prescribed standards of quality in all research, customer and partner contacts/service functions and promotes customer satisfaction/loyalty through quality contact and timeliness of responses, achieves quality audit results as required.
• Participates and represents PHS/PHP in outreach events to include, but not limited to enrollment fairs, site visits, health fairs, job fairs, Member Focus Groups, Provider Information Sessions, Provider Focus Groups and ANOC meetings held throughout the state.
• Assists in the development of documentation of process and procedures into functional process improvements to enhance overall level of service to our customers and partners. Uses the Improvement model, identifies patterns in call inquiries/grievances, c