This position is responsible for working in a fast-paced environment using several modes of communication including face-to-face, video conferencing, telephone, chat, messaging, and email. Representative must be able to master systems and technology associated with the role and be comfortable working efficiently while multitasking.
A representative must have excellent interpersonal skills to understand customer inquiries or complaints and manage through potential difficult conversations. Representative must maintain this level of service while working with complex situations and high volumes. Representatives will act as the voice of the customer, advocating on their behalf to ensure they receive best in class service by proactively identifying and escalating priority issues, de-escalating when appropriate, and going above and beyond to meet customer needs. They must be able to learn quickly so they can acquire the service and product knowledge to answer customers’ questions accurately. Their work must be concise and accurate. They must have good knowledge of telephone and computer systems so they can use engagement center systems efficiently. This will be done in a consistently service-oriented manner to provide the highest level of satisfaction. The representative makes no medical necessity decisions.
Representatives must aim to deal with customer’s inquiries and requests on the first call and be willing to be flexible to meet the customers’ needs. Concise and accurate documentation in systems of record are required using correct grammar and complete sentences.
The Engagement Center remote shifts occur on a set schedule. Representatives are expected to be available for the entirety of their shift and work in a quiet private place that upholds HIPPA standards. Representative must be willing to work at the times needed to provide service to meet customer needs. Some positions include evening, night, weekend, and holiday hours.
Incumbent will provide a variety of services to customers. These can include, but are not limited to:
• Provide excellent service utilizing basic knowledge of all services supported for Hometown and Renown Health.
• Follow established standard policies and procedures to complete pertinent tasks, meet customer needs, and work for one call resolution.
• Answering and routing of high volume of inbound/outbound interactions through multiple channels and computer software systems. Communicating with customers to resolve inquiries using various platforms.
• Coordinating healthcare services including appointment scheduling, updating patient records, obtaining authorizations, communicating with care teams, arranging transportation, paging on-call physicians, escalating patient concerns, general compliant and grievance resolution, basic navigation of the healthcare system, providing technical support, and payment collection.
• Provide appropriate responses to its customers and consumers regarding Plan benefits to include, but not limited to eligibility, benefit quoting, provider network, referral and authorization process, claims payment, as well as policies and procedures.
• Work effectively with professionals across the health system including providers, social workers, case managers, nurses, medical assistants, patient access representatives, insurance companies, and other third parties.
• Handle inquires related to compliance and regulatory auditing.
• Information intake and analysis to determine appropriate level of care and priority.
• Scheduling of advanced modalities or highly specialized appointments for consultations, exams, and procedures.
• Coordinate with appropriate care team (internal & external) to ensure seamless patient experience and timely resolution of all patient needs
• Perform service recovery to retain positive customer relationships and utilization of the health system to retain and promote customer loyalty.
• Utilize judgement and discretion to complete pertinent tasks, meet customer needs, and work for one call resolution. Be able to use critical thinking and creative solutions when established policies and procedures fail.
• Able to work through and resolve complex claims and payment processes.
• Role model of professionalism and supports a culture of patient centeredness and just culture, “see something, say something”.
• Provides support to team members as necessary to assist with education, training, and escalated calls.
Performs other duties as required as well to meet and exceed performance goals to ensure all departmental & organizational goals are achieved.