Non-Clinical - Administrative - Customer Service Representative

Customer Service Representative

The Customer Service Representative is the primary liaison between callers (members and the general public) and the medical group. Customer Service Representatives will field inquiries across a wide range of healthcare issues and subjects. They will be required to have considerable knowledge about the hospital, the medical staff, the integrated delivery system, the community, health plans, and the sources of information relevant to this data.

Specific skills needed:

• Self-motivated.
• Positive attitude.
• Excellent verbal and written skills.
• Ability to learn quickly.
• Possess strong computer skills.
• Data entry experience preferred.
• Deal effectively in a fast-paced, changing environment.
• Good organizational skills.
• Ability to work independently as well as be part of a team.
• Develops effective working relationships with all levels of the organization, including administration, doctors, and staff.
• Ability to identify and solve problems.
• The ability to talk to callers in all walks of life and in all situations via telephone and build a sense of trust and rapport with the caller and intent of the call.
• The ability to understand the requirements of a substantial number of health plans, in order to assist patients in selecting a physician, accessing services, and resolving billing issues.
• The ability to record information, in a database, accurately and rapidly.
• Respond to caller inquiries by summarizing what is often confusing and difficult to understand information.
• The ability to perform well in a teamwork environment and to maintain a positive attitude in a busy and high-pressure work situation.
• The demonstrated ability to speak and write in articulate and grammatically correct English and also converse in Spanish or Chinese if identified in the specific position requirements.

Education/experience/training required:

• High school graduate or equivalent required.
• Experience working with telephone callers, preferably in a healthcare setting, or the ability to demonstrate the aptitude for such work.
• Training or experience in a Microsoft Windows environment required.

Job responsibilities:

• Document each telephone call.
• Assist callers with community education questions.
• Provide material on screenings and promotional events that may take place with affiliated partners.
• Inform callers as to which health plans are affiliated with Presbyterian Health m.
• Link (transfer) misdirected callers to PIH or the health plan if necessary.
• Claims Status Calls
• Assist members who have n;..:i.;ivc1.
• Resolve issues by getting the specific billing information from the member and calling the provider to straighten out any billing issues.
• Assist providers with claims status information regarding claims payment.
• If a claim was denied, the provider must appeal the decision in writing.
• If a claim is not in the system, instruct the provider to mail the claim to the appropriate address.
• If a claim was processed in error, collect specific billing information and submit to Claims Supervisor for investigation.
• Utilization Management Referral Authorization Calls
• Assist members and providers with referral authorization status.
• Eligibility Status Calls
• Assist member, provider, and health plan with eligibility status.
• Compiles materials for mailings to callers upon request.
• Works in the spirit of cooperation and understanding with management other staff members.
• Attends and participates in staff meetings as required.
• Ensures compliance with established departmental and organizational policies and procedures.
• Keeps workspace in a neat and organized way.
• Ensures that confidentiality of all sensitive information affecting the Company's finances or public image is properly safeguarded.
• Any and all other tasks as assigned by manager.

Teamwork/customer service responsibilities:

• Value: Each person is treated with respect, dignity, fairness and compassion. Behavior: Performance is acceptable when everyone is promptly greeted with a smile in a warm and caring manner using the person's name whenever possible. No matter how I feel, I display a caring attitude.
• Value: Each person displays loyalty and pride in PIH Health and upholds the confidentiality of patients, visitors, physicians, and co-workers.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.