First Call Resolution Jobs in Nevada (NOW HIRING)

Position Purpose

This position represents the front door of the organization to ensure health care is received timely with an exceptional customer experience. This position will act as a liaison, primarily a patient advocate, between Renown, Hometown Health, its customers, and community members by processing requests, complaints, concerns, providing education in utilizing the resources and services of the organization resulting in “first call resolution”. The successful Customer Engagement Representative is responsible for going above and beyond to provide an excellent experience in a professional, expedient, and proficient manner. This position serves as the voice of the customer and will engage with peers, office staff, and leaders to resolve or escalate questions and concerns. This is a personally fulfilling role as it provides the opportunity to make a genuine difference in each life that is touched.

Nature and Scope

This position is responsible for working in a fast-paced environment using several modes of communication including face-to-face, video conferencing, telephone, chat, messaging, and email. Representative must be able to master systems and technology associated with the role and be comfortable working efficiently while multitasking.

A representative must have excellent interpersonal skills to understand customer inquiries or complaints and manage through potential difficult conversations. Representative must maintain this level of service while working with complex situations and high volumes. Representatives will act as the voice of the customer, advocating on their behalf to ensure they receive best in class service by proactively identifying and escalating priority issues, de-escalating when appropriate, and going above and beyond to meet customer needs. They must be able to learn quickly so they can acquire the service and product knowledge to answer customers’ questions accurately. Their work must be concise and accurate. They must have good knowledge of telephone and computer systems so they can use engagement center systems efficiently. This will be done in a consistently service-oriented manner to provide the highest level of satisfaction. The representative makes no medical necessity decisions.

Representatives must aim to deal with customer’s inquiries and requests on the first call and be willing to be flexible to meet the customers’ needs. Concise and accurate documentation in systems of record are required using correct grammar and complete sentences.

The Engagement Center remote shifts occur on a set schedule. Representatives are expected to be available for the entirety of their shift and work in a quiet private place that upholds HIPPA standards. Representative must be willing to work at the times needed to provide service to meet customer needs. Some positions include evening, night, weekend, and holiday hours.

Incumbent will provide a variety of services to customers. These can include, but are not limited to:

• Provide excellent service utilizing basic knowledge of all services supported for Hometown and Renown Health.

• Follow established standard policies and procedures to complete pertinent tasks, meet customer needs, and work for one call resolution.

• Answering and routing of high volume of inbound/outbound interactions through multiple channels and computer software systems. Communicating with customers to resolve inquiries using various platforms.

• Coordinating healthcare services including appointment scheduling, updating patient records, obtaining authorizations, communicating with care teams, arranging transportation, paging on-call physicians, escalating patient concerns, general compliant and grievance resolution, basic navigation of the healthcare system, providing technical support, and payment collection.

• Provide appropriate responses to its customers and consumers regarding Plan benefits to include, but not limited to eligibility, benefit quoting, provider network, referral and authorization process, claims payment, as well as policies and procedures.

• Work effectively with professionals across the health system including providers, social workers, case managers, nurses, medical assistants, patient access representatives, insurance companies, and other third parties.

• Handle inquires related to compliance and regulatory auditing.

• Information intake and analysis to determine appropriate level of care and priority.

• Scheduling of advanced modalities or highly specialized appointments for consultations, exams, and procedures.

• Coordinate with appropriate care team (internal & external) to ensure seamless patient experience and timely resolution of all patient needs

• Perform service recovery to retain positive customer relationships and utilization of the health system to retain and promote customer loyalty.

• Utilize judgement and discretion to complete pertinent tasks, meet customer needs, and work for one call resolution. Be able to use critical thinking and creative solutions when established policies and procedures fail.

• Able to work through and resolve complex claims and payment processes.

• Role model of professionalism and supports a culture of patient centeredness and just culture, “see something, say something”.

• Provides support to team members as necessary to assist with education, training, and escalated calls.

Performs other duties as required as well to meet and exceed performance goals to ensure all departmental & organizational goals are achieved.

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications
Requirements - Required and/or Preferred

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. A college degree or equivalent experience is preferred by not required.

Experience:

Successful completion of Customer Engagement Representative 1 OR 2-3 years of experience in customer service, healthcare, or health insurance with demonstrated competence within 90 days of hire.

Required to have strong customer services skills. Ability to speak Spanish desired.

License(s):

None

Certification(s):

Certified Medical Insurance Specialist Preferred

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, teams, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Ability to type average of 40 WPM. Experience with electronic medical record systems is a plus.