Customer Care Coordinator 1 - Customer Service Administrative Services Only at Providence Health Plan Partners
The Customer Care Coordinator is a member of a service team that supports multiple regions and whose primary purpose is to provide Health Plan customers with outstanding, seamless service in a call center based team environment.
Responsible for the first line of communication with a variety of customers, including existing and potential members, providers, internal departments and employers. Will provide detailed benefit quotes, eligibility and premium information on a broad portfolio of products, assist members in selecting medical homes and primary care physicians, educate members and providers in the appropriate use of health plan and clinic services, research and respond to claims and authorization inquiries, knowledge of complex custom networks, and resolve customer issues and concerns.
Schedule: Monday - Friday 8am to 5pm (PST) * T his role is remote but may require in-office training 2 day per week and webcam visibility for team meetings and/or training as needed.
Majority of communication is done by telephone with limited face to face customer service.
Effectively establishing priorities in an environment of competing urgent demands.
Developing a comprehensive knowledge of claims adjudication, applying concepts and theory in the absence of hands on claims training/experience.
Maintain detailed knowledge of Health Plan products, provider networks and funding arrangements, community resources, health care industry trends, CMS & DCBS rules and regulations.
Develop and maintain a comprehensive knowledge in a complex and rapidly changing environment required to support the Affordable Care Act and Cover Oregon Federal Exchange requirements; in addition to a growing number of unique administrative service arrangements.
Effectively handle angry members or providers by identifying the source of their dissatisfaction, diffusing their anger, and resolving the situation which may require coordination with multiple individuals or departments.
Research and respond to member, provider, employer group and other internal and external questions, concerns, needs. Provide education to both members and providers as appropriate
Advocate for the customer. Explain benefits in a detailed and courteous manner so they are understood. Educate members to promote utilization of products and services to their full advantage and to optimize the value of their healthcare dollar
Critical thinking skills in order to problem solve when a root cause of an issue is not apparent
Ability to work in a Multi-Channel Contact Center environment both by phone, in person and over email
Facilitate resolution of member or provider's issues in a timely, efficient and professional manner
Document all calls in accordance with company standards and resolve inquiries at point of service when appropriate. First call resolution is the desired outcome
Demonstrated data entry skills and PC processing skills in a Window based environment
Strong verbal, written and interpersonal skills
Skillful at providing and receiving feedback to improve personal performance and team effectiveness
Multi-tasking skills with the ability to talk and type
- 2 years experience in a high pressure customer facing service environment with a proven track record of learning and applying complex concepts.
Basic medical terminology, CPT, ICD9-10 coding knowledge.
Behavioral Health knowledge.
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits — see our website for details — http://www.providenceiscalling.jobs/rewards-benefits
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.
We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.
We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.
Requsition ID: 103472
Company: Providence Jobs
Job Category: Claims
Job Function: Revenue Cycle
Schedule: Full time
Career Track: Admin Support
Department: 5018 OPS CUSTOMER SERVICE ASO OR REGION
Address: OR Beaverton 3601 SW Murray Blvd
Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.