Presbyterian Healthcare Services
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PCSC HEALTH PLAN CSR
at Presbyterian Healthcare Services
- Requisition ID
- Call Center
- Default: Location : City
- Location : Name
- Rev Hugh Cooper Admin Center
- Default: Location : State/Province (Full Name)
- New Mexico
Type of Opportunity: Full Time
Work Schedule: Days
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
*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.<B
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.
* High School Diploma or GED
Benefits are effective day-one (for .45 FTE and above) and include:
- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
Presbyterian Healthcare Services is 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, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
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's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
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.