Call Center Representative

3 months ago

New Haven, United States Yale New Haven Health Full time

Overview:
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Responds to a wide range of customer calls in a fast-paced call center environment and correspondence regarding third party coverage to ensure that patient accounts reflect accurate information. Directs the work of other staff members throughout the departments in order to facilitate the process and achieve resolution. Must handle an extremely heavy volume of patient calls and analyze third party information and coverage issues in order to resolve patient accounts (i.e. including eligibility periods, coverage information, etc.) provided and determines which of the patient's accounts it applies to. Complies with all HIPPA verification procedures to ensure that you are speaking with the appropriate party prior to providing information. Takes appropriate action to resolve account balances while ensuring the Hospital's image of good customer relations is maintained at the highest level. Researches and investigates patient inquiries in order to direct patient inquires to the correct source or follow up to resolve their issues. This involves the coordination of information from the patient, clinical areas, government agencies and insurers in or to reconcile the account. Individual should be detail-oriented and possess excellent analytical skills in order to resolve the more complex patient inquires. Must balance good customer service skills with the need to expedite calls in order to meet the heavy demands. Applies knowledge of federal and state regulations/laws including fair debt act, when attempting to collect balances or discussing other patient payment options over the telephone. Spanish speaking preferred.

EEO/AA/Disability/Veteran

Responsibilities:

  • 1. Handles a high volume of incoming calls in a call center environment regarding patient and third party information to ensure that accounts reflect accurate information and third party coverage. Determines the appropriate corrective action and takes the necessary steps to insure that the account is resolved in a timely manner while documenting all actions in the system. Coordinates the efforts of other staff members throughout the departments in order to expedite account resolution and the response to the patient.
    • 1.1 Determines the nature of the inquiry upon receiving the call as
      monitored by the supervisor.
  • 2. Analyze the problem accounts and correspondences as it pertains to accounts and provide caller or inquirer with a seamless experience. Responds to complex mail responses not handled by Support Area, taking corrective action to ensure effective billing and facilitates the workflow in the area.
    • 2.1 Provides the documentation necessary within forty-eight (48) hours to resolve administrative complaints and notates the system.
  • 3. Maintains and adds to personal knowledge by keeping informed of billing and payment policy updates to regulations and procedural changes and attending meetings and seminars, to effectively carry out assigned duties.
    • 3.1 Reviews all memo and policy updates as they are distributed by the supervisor, to ensure current billing procedures are followed.
  • 4. Promotes Patient Centered Care Concept throughout the organization. Participates in work groups to analyze, identify, plan, develop and implement changes to enhance the overall performance of the department.
    • 4.1 Participates in any on-going in service training to ensure a clear understanding of departmental procedures and communicate any changes to staff as it relates to this specific service line.


Qualifications:

EDUCATION

(number of years and type required to perform the position duties): High school diploma with business related courses. Associates degree preferred. Certified Customer Experience Professional (CCEP) through the Customer Service Institute of America (CSIA) or agree to obtain within 6 months of hire.

EXPERIENCE

Two years customer service experience in a fast-paced customer service environment. One year of experience processing healthcare claims preferred.

LICENSURE

Certified Customer Experience Professional (CCEP) through the Customer Service Institute of America (CSIA) or agree to obtain within 6 months of hire.

SPECIAL SKILLS

Strong customer service skills and ability to resolve complex problems in a quick and effective manner, demonstrated ability to develop strong relationships in order to partner with others to provide highest level of customer service. Excellent oral/written communication skills with ability to communicate complex requirements across clinical and financial disciplines. Demonstrates resourcefulness to accomplish many tasks and balances multiple priorities in a tense, highly active environment. Comprehensive PC proficiency, keyboarding and the capability to navigate various software and spreadsheet systems. Spanish speaking preferred.

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