Call Center Appointment Service Coordinator - Remote

Description:

• Must be within 75 miles of the Duluth, GA Contact Center

The Coordinator, Call Center Appt Services utilizes guidelines and protocols to increase customer satisfaction and retention by providing Health Plan customers with assistance and information to interpret health plan benefits. Customers include but are not limited to Members, Physicians, Member Service Reps, Clinical Supervisors, and Advice Nurses. The associate serves to facilitate or assist with member transfer and transport and is also responsible for facilitating communication between the advice nurses and the On-Call Providers.
Essential Responsibilities:

• Train or orient new or less experienced staff through on the job-training programs. Works with leadership and stakeholders as a Subject Matter Expert to improve training, development and implementation of guidelines/policies and workflows to improve the member experience.
• Participates in special projects, studies, or other duties as assigned to ensure patient safety or a hassle-free call handling experience. Proactively identify ways Kaiser Permanente could improve customer service; work in collaboration with partners throughout Kaiser Permanente.
• Maintains updated and accurate information on core hospitals diversion status. Notifies appropriate staff and business partners of diversion status. They will coordinate with systems outside of KPGA to include external specialists, follow-up ER visits, and follow-up hospital discharge visits.
• Provide appropriate benefit coverage, member eligibility, patient financials, and claims services to members. Educates members on proper use of Health Plan systems and facilities. Providing patients with information/instructions about appointments and procedures. The associate will also provide status on payments of post-service claims, assist members in receiving health care services including the use of Kaiser Permanente facilities, and investigate inquiries about service-related concerns.
• Utilize electronic medical records systems to access member information adhering to standards for the protection of PHI and PPI while supporting scheduling functions. Respond to member questions and concerns, and acts as an advocate for their service, needs, and interests within Kaiser Permanente. Will schedule, reschedule, cancel and verify patient appointments, utilizing established guidelines to schedule appointments for all departments while maintaining accurate call documentation. The associate will identify and locate appointments that generally hinder the Advice Nurses from focusing on triage, patient assessment, and advice. This position is responsible for ensuring timely and efficient practitioner to practitioner contact; hospital to practitioner contact; member to hospital and/ or practitioner contact, etc. The associate is responsible for complete, accurate data entry of all referrals for the assigned specialty, distribution of internal referral letters, and maintaining waitlist for multiple specialty departments. The associate will also assist members in obtaining medical services and scheduling them for provider encounters. They will follow established policies and procedures to schedule members, transfer callers to Advice Nurses, or the appropriate medical office.
• Deliver service ensuring productivity, quality, and service goals are met. Provides proper and accurate documentation. Ensures adherence to business practices and policies. Collect cumulative data and statistics and enters data into automated systems. The member encounters will be conducted in a prompt, professional, concise, courteous, standardized, and accurate manner to assure high-levels of customer-focused services. Must demonstrate leadership skills and be able to work independently. Must have the ability to support the creation of a positive work environment. Provides proper and accurate documentation.

Basic Qualifications:
Experience

• Minimum two (2) years of experience in a claims paying environment, clinical office environment or contact center.
• Minimum two (2) years of experience in a similar customer service position which included data entry and high volume phone duties.

Education

• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• N/A.

Additional Requirements:

• Ability to communicate effectively and courteously on the telephone.
• Appointment-setting experience in a clinical setting or health care service role.
• Type a minimum of 30-wpm.
• Demonstrated ability to independently manage difficult customers.
• Ability to effectively interact and negotiate with diverse work units at all organizational levels.
• Complete a Customer Service Assessment.
• Demonstrated analytical and problem-solving skills.
• Knowledge of medical terminology.
• Excellent verbal and written communication skills required.
• May sit in the contact center or medical office.
• Customer service aptitude demonstrated through Customer Service Assessment.
• Medical terminology, CPT and ICD-9 coding knowledge required.
• Working knowledge of PC and computer software (i.e. Microsoft Office, CRM Documentation, and EMR Tools).
• Demonstrated competency with Microsoft Word.
• Ability to effectively interact and negotiate with diverse work units at all organizational levels.

Preferred Qualifications:

• Minimum four (4) years of call center experience representing managed care or health insurance customer service.
• Minimum two (2) years of experience in a claim paying environment.
• Bachelor's degree preferred.
• Minimum five (5) years of related business experience.