Call Center Representative

POSITION DESCRIPTION:

Answers incoming calls, assesses the urgency of the call, appropriately triages and directs urgent calls according to established procedures to ensure optimal quality patient care.  Schedules patient appointments, communicates and coordinates scheduling with clinical personnel to optimize patient care and efficiency.  Manages patient referrals and/or prior authorizations, by receiving requests from internal and external customers and ensures that all requests are processed correctly and in a timely manner.  Provides a high level of customer service to all internal and external customers.

ESSENTIAL JOB FUNCTIONS:

1. Answers incoming calls, assesses the urgency of the call, appropriately triages and directs urgent calls according to established procedures to ensure optimal quality patient care; may schedule appointments for urgent problems; communicates and coordinates scheduling with clinical personnel to optimize patient care and efficiency.
2. Accurately and competently pages appropriate on-call providers.
3. Schedules patient appointments; obtain appropriate information, enter preliminary account data into computer.
4. Record messages for physicians and staff accurately, with complete information required, and ensures that it is tasked appropriately through IHA EMR system. 
5. Assists patients with MyChart-related questions. Keeps current on MyChart updates, changes and FAQ’s.
6. Accurately completes the call center tool. Uses the call log and on-call MD calendar accurately and appropriately.
7. Reviews, monitors and performs follow up on all referral requests and authorizations for outpatient procedures and/or surgeries which may include contacting specialists, insurances, practices and patients.
8. Obtains out of network authorizations whenever possible to help patient comply with Primary Care Provider requests.
9. Accurately documents notes into IHA systems concerning the status of referrals, authorizations or other patient information; Answers patient, insurance and office calls related to referrals and prior authorizations. 
10. Maintain familiarity with physician office and Business Services department basic services and hours of operation to respond to customer request accurately and promptly.
11. Ensures that any pending items received during the previous shift have been appropriately resolved.
12. Performs other duties as assigned

ORGANIZATIONAL EXPECTATIONS:

1. Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of both IHA and Trinity Health.
2. Must be able to work effectively as a member of the Call Center team.
3. Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers.
4. Maintains knowledge of and complies with IHA standards, policies and procedures.
5. Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems.
6. Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines.
7. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities.  Embraces new ideas and respects cultural differences.
8. Uses resources efficiently.
9. If applicable, responsible for ongoing professional development – maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.

MEASURED BY:

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

ESSENTIAL QUALIFICATIONS:

EDUCATION:  High school diploma or equivalent

CREDENTIALS/LICENSURE:   None

MINIMUM EXPERIENCE:   Up to 3 years’ previous experience in a combination of patient services, medical reception, call/customer service center (medical environment) or other relevant business environment.

POSITION REQUIREMENTS (ABILITIES & SKILLS):

1. Knowledge of Call Center protocols, processes and procedures related to position responsibilities.
2. Sufficient knowledge of mathematics.
3. Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, EMR, ShoreTel, NextGen, Microsoft Word and Excel, intranet and computer navigation.  Ability to use other software as required while performing the essential functions of the job.
4. Excellent communication skills in both written and verbal forms, including proper phone etiquette. 
5. Ability to work collaboratively in a team-oriented environment; courteous and friendly demeanor.
6. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, patients, family members, insurance carriers, and vendors.
7. Ability to cross-train in other areas of the department in order to achieve smooth flow of all operations.
8. Ability to work a flexible schedule during assigned shift and cover absences in other shifts as needed.
9. Good organizational and time management skills to effectively juggle multiple priorities and time constraints.
10. Ability to exercise sound judgement and problem-solving skills, specifically as it relates to resolving or escalating difficult or complex issues to appropriate areas as needed.
11. Ability to handle patient and organizational information in a confidential manner.
12. Successful completion of IHA competency-based program within introductory and training period.
13. Sufficient knowledge of medical terminology, billing, insurance, referrals and authorizations to perform responsibilities.

MINIMUM PHYSICAL EXPECTATIONS:

1. Physical activity that often requires keyboarding, filing and phone work.
2. Physical activity that often requires extensive time working on a computer.
3. Physical activity that sometimes requires walking, standing, bending, stooping, reaching, and/or twisting.       
4. Physical activity that sometimes requires lifting, pushing and/or pulling under 30 lbs.
5. Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus. 
6. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
7. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

MINIMUM ENVIRONMENTAL EXPECTATIONS:

This job operates in a typical office environment which involves frequent interruptions and significant interaction with people which can be stressful at times.