Lead Customer Service Center

Presbyterian is seeking a Lead Customer Service Center.

Responsible for providing customer service for: members in the Salud, Medicare, IBAC, and Commercial plans; Provider Care; PMG patient scheduling; Financial Services; and Broker Services. Assist the PCSC Supervisor in a lead role to ensure that all functions related to the Customer Service Center are performed in compliance with the requirements of Federal and State regulations, employer group contracts, and PHS/PHP performance standards

We're determined to take care of those working in healthcare.

Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

Why Join Us

• Full Time - Exempt: No
• Job is based at Presbyterian Rust Medical Ctr
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

• High school diploma plus one year of call center experience preferred.
• Managed care experience with possible enrollment experience preferred.
• 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 and some knowledge of risk sharing programs helpful.
• Some knowledge of Amisys, Cactus, Facets, Epic, Medipac, Partner and PACIS 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. Ability to type 30 wpm with 90% accuracy.

• Responds to first level escalations and acts as member/patient advocate in dealing with practitioners, employer groups, and brokers. Responds to customer appeal/grievances, verbal and written, in accordance with established policies and procedure to ensure problem resolution for the customer.
• Develops peer team members skills and performance, providing targeted ongoing coaching, and facilitating CSRs' ongoing learning to meet customer expectations, resulting in high employee-customer satisfaction scores.
• 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 and first escalations. Conducts outbound calls as required and meets established quality/quantity guidelines supporting PHS/PHP/PMG initiatives and/or programs.
• 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 and initiatives (Sniper, CRM, etc.).
• Assist in coordinating (when necessary) meetings with customers or partners for training, contracting, and reporting.
• Perform other functions as required.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

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.

About Presbyterian Healthcare Services
Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. 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.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $25.96/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.