Call Center Representative - Managed Care

SEMRHI•Hattiesburg, MS

About The Position

Under the direction of the Value Based Coordinator, the Call Center Representative – Managed Care, performs a variety of tasks related to answering incoming telephone calls from patients, schedule appointments, make follow-up calls to patients, create new medical records, enter and verify demographic information for specific patient populations with a design to meet specific contractual and program related requirements. The Call Center Representative – Managed Care, ensures that patients are scheduled for necessary medical appointments as it relates to improving the health status and care for individuals with chronic conditions with complex medical, mental health and psychosocial issues, while also delivering great experiences through compassionate interaction to ensure patient satisfaction. The Call Center Representative – Managed Care, must demonstrate the ability to be a team member and skills to appropriately communicate and interact with patients of all age groups, while being sensitive to their culture and religious beliefs.

Requirements

Working Knowledge of Microsoft Office
Working Knowledge of the Aledade App
General knowledge of medical terminology
General knowledge of managed care concepts and practices
General knowledge of HIPPA and related patient privacy regulations
Skill at deescalating irate patients
Ability to work in a high stress environment
Ability to adapt to quickly changing priorities
Ability to multi-task while maintaining a professionalism and a positive attitude
High school diploma or GED
Must demonstrate basic computer and advanced typing skills
1 year of call center experience

Nice To Haves

Experience in a health/clerical related field is preferred

Responsibilities

Utilizes multiple software applications to work on call lists of patients who are delinquent for various medical appointment.
Calls patients and explains the delinquent medical services that are needed
Completes the scheduling process by booking appointments, reminding patients what to bring to their visit, and providing an arrival time frame that allows the patient to complete all of the necessary paperwork relating to their visit.
Registers patients by entering or updating patient information in the Epic system
Works closely with managed care clinical staff to assist with chronic care appointments.
Works to achieve or surpass all daily, weekly and monthly goals as set out by payor contracts and established by the Value Based Coordinator
Works closely with clinic staff to insure best practices for scheduling
Maintain AHT, Quality Assurance, AUX, hold times, and schedule adherence at or above the expected performance level for each metric
Evaluates every interaction by using active listening and critical thinking skills to determine the level of urgency for that specific contact.
Accurately captures call details using SeMRHI’s customer relationship management software
Remain calm under pressure and effectively resolve patient complaints
Resolves every patient compliant by displaying ownership in the resolution of the patient’s concern.
Respects patient’s privacy, dignity, and cultural beliefs in all interactions
Ensures confidentiality by abiding by applicable laws, regulations, and SeMRHI policies when working with Protected Health Information
Assists with the orientation and training of other employees
Cross train to other positions, as directed
Performs all other duties, as assigned
Completes the required IT/Security trainings prior to the deadline