Logo

Customer Service Rep

Confluence Health

Wenatchee, WA

Confluence Health

Accountable Care - Enrollment

Full Time

Day Shift

80

19253

Position Summary:

 

Provides customer service to members, providers, and vendors associated with the prepaid health insurance plans that are serviced by Confluence Health through the Accountable Care Department.

Essential Functions:

1.     Responsible to takes calls and problem solves for claims inquiries, member and provider concerns.

2.     Responsible to document referral, authorizations and termed members.

3.     Receives and problem solves all customer service email correspondences in a timely manner.

4.     Sorts mail for designated department.

5.     Follow through on all pending work in a timely manner.

6.     Communicates with members, providers, or vendors to keep them informed.

7.     Provides resolution in a timely manner.

8.     Is a patient and active listener to accurately understand and quickly respond to issues.

9.     Can be a problem solver including exhaustively researching an issue.

10.  Solves problems the first time and sets timeline expectation of resolution to customers.

11.  Keeps pace with workflow.

12.  Demonstrates the ability to multi task.

13.  Uses sound judgement to be able to determine customer needs and redirect to appropriate staff if beyond scope of knowledge or responsibility.

14.  Accurately notes issues, work completed and actions taken in tracking module per established procedures and timeline.

15.  Insure member demographics are maintained as accurately as possible within the managed care system and Confluence Health records.

16.  Coordinate with other internal Confluence Health Departments and sponsoring health plans as necessary to ensure the highest level of service.

17.  Provides effective two-way oral and written communication with all coworkers and interested parties so that everyone understands issues, how they are to be resolved and time line for resolution.

18.  Understands and makes use of the decision-making authority that has been granted and uses sound judgement to know when to ask for assistance.

19.  Adheres to teamwork standards.

20.  Adheres to Code of Conduct standards.

21.  Remains open, willing and supportive of change.

22.  Maintains high standards of professional dress as outlined in the office dress code

23.  Understands the implications that tardiness and attendance has on customers service and the team.

24.  Remains calm, patient and reasonably unaffected while working under pressure.

25.  Adheres to Confluence Health and departmental Personnel policies as presented in the Employee Handbook.

26.  Attends all required department meetings.

27.  Keeps work area neat and organized.

28.  Other duties as assigned.

Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.

Qualifications:

Required:

    • High School graduate or equivalent required.

Desired:

    • Proficient to read, write and speak English.
    • Proficient in basic math functions.
    • Proficient in letter writing skills and the use of effective communication skills to convey ideas or concepts.
    • Possesses intermediate computer skills (e.g., spreadsheets, word processing) knowledge of MS office.
    • Knowledge of ICD-10, CPT coding, medical terminology, and insurance billing desired.
    • Possesses intermediate computer skills (e.g., spreadsheets, word processing) knowledge of MS office.

Who We Are: Confluence Health is an integrated healthcare delivery system that includes two hospitals and more than 40 medical specialties, to provide comprehensive medical care in North Central Washington. With over 270 physicians and 150 advanced practice clinicians, Confluence Health is the major medical provider between Seattle and Spokane. Our goal is to deliver high-quality, safe, compassionate, and cost-effective care close to home. Staying on the leading edge of healthcare innovation is important, so we invest in technology--to provide better care for our patients and allow our providers to operate at the highest level. Our Mission: We are dedicated to improving our patients' health by providing safe, high-quality care in a compassionate and cost-effective manner. Our Vision: To become the highest value rural healthcare system in the nation that improves health, quality of life, and is a source of pride to those who work here.