Presbyterian Health Services – Call Center Representative/Work From Home – Albuquerque, NM

Job title: Call Center Representative/Work From Home Company: Presbyterian Health Services Job description: Overview This is a work from home opportunity for individuals living within the state of New Mexico. Responsible for providing customer service for members and providers in all PHP benefit plans. Ensure callers receive service excellence when responding to telephone, written, Pres Online, E-Business, chat, and in person inquiries Type of Opportunity: Full Time FTE: 1.000000 Exempt: No Work Schedule: Days

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 (Centennial Care, 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, conducts root cause analysis in resubmitted and adjusted claims and reports to management team.
• Researches inquiries/special projects as requested and responds to customer, partner or other PHS/PHP business units to ensure accuracy of benefit interpretation with results of research and resolution and within required timelines. Responses to customer or partners to be done using Microsoft Word, Excel or similar databases when appropriate. Uses 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.
• Participates as an effective and active team member both individually and in a team environment. Participates in a value-added manner as a team member to internal teams as well as other process improvement teams (i.e. 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.
• Perform other functions as required.

Benefits

We offer more than the standard benefits! Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more! Learn more about our employee benefits: Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more. Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans. About Presbyterian Healthcare Services Presbyterian Healthcare Services 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. About Our Regional Delivery System Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico continues to grow steadily in population and features a low cost-of living. Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes. New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Expected salary: Location: Albuquerque, NM Apply for the job now! Apply Job! Apply to this Job