Scheduling Customer Service Representative

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.

Responsibilities

Provide customer service for patients regarding 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; Conduct outbound calls as required; Develop and maintain positive customer or partner relationships and act as member/patient advocate; Assist in developing documentation of processes and procedures into functional process improvements; Identify patterns in call inquiries/grievances, conduct root cause analysis in resubmitted and adjusted claims, and report to management team; Research inquiries/special projects and respond to customers, partners, or other PHS/PHP business units to ensure accuracy of benefit interpretation; Participate as an effective and active team member, including process improvement teams (i.e. QCC) and initiatives; Record all calls, mail, email, faxes, walk-in encounters, etc. in appropriate databases; 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 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; 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; 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

Nice to have

Some knowledge of risk sharing programs helpful; Some knowledge of CRM and EPIC; Knowledge of other databases used PHS Enterprise wide

Benefits

Comprehensive benefits package for benefits-eligible employees including medical, dental, vision, short-term and long-term disability, group term life insurance, and other optional voluntary benefits; Employee Wellness rewards program with gift cards and wellness activities