05/02/2023
HIRING: Member/Provider Services Concierge
WHO ARE WE: THE PREFERRED HEALTHCARE SYSTEM
Located in Central Pennsylvania, we are a regionally based organization, incorporated in 1985 as a joint venture between Altoona Hospital and a group of physician investors. The goal of this organization is to work with area employers to provide quality, cost-effective healthcare benefits for their employees and families.
The Preferred Healthcare System (PHS) works through insurers and third-party administrators to provide a network of hospitals, physicians, and ancillary providers who can deliver a broad scope of healthcare services. Through key agreements members using the PHS network have access to specialty care not available in our 10-county licensed service area; these provider systems include Allegheny Health Network, Penn State Health, and UPMC.
PHS provides this network of hospitals and physicians throughout Central Pennsylvania. PHS currently has contracts with primary care hospitals and their physicians, as well as arrangements for medical services not available in this area.
WHO WE SERVE:
Our customers include but are not limited to: Members enrolled in the network, Employer Groups accessing the network, participating providers in the network, Administrators of health plans using the network.
OUR VISION:
Providing health care solutions to employer groups outside of the standard options available through the current marketplace. Our goal is to use resources in the community to provide affordable health care solutions to our own community. For the first time we are having conversations with all parties involved in health care to deliver a cost-effective solution for our community members. Physicians, facilities, employers, and members have input on how the network contracts its providers to provide excellent, affordable health care to the area.
POSITION PURPOSE:
Improving members' experiences is at the heart of every employee at Preferred Healthcare System. We strive every day to make sure that our members have access to the high-quality health care they need and deserve.
JOB SUMMARY:
Responsible for accomplishing their primary goal of providing support and rendering thorough, excellent customer service by addressing calls related to inquiries, questions and concerns in all areas including enrollment, benefit interpretation and eligibility for medical care. Maintains confidentiality per HIPAA guidelines.
JOB RESPONSIBILITIES:
• Responsible for responding to telephone and/or written inquiries, working independently and consistently meeting customer needs. Receive, research, and process information from member or provider to determine needs/wants and ensure customer questions have been addressed. Determine appropriate action to be taken.
• Read and interpret contract language, gather appropriate documents, i.e., claim copies, claim history data, cancelled checks, on-line status, Explanation of Benefits (EOBs), and utilize applicable terminal screens including on-line documentation, intranet, and internet navigation.
• Initiate and track corrections that need to take place with Administrators of plans. Communicate status and resolutions to customers.
• Analyze inquiries to anticipate and determine inquirer’s needs and next action to be taken to respond in a prompt and accurate manner.
• Deliver agreed upon actions at stated time. Provide updates if delays occur.
• Collaborate with providers, families, and patients by ensuring communication is open and information appropriately shared (in compliance with HIPAA) to ensure member’s and provider’s needs are met.
• Obtain required or missing information via correspondence or telephone.
• Provide appropriate amount of information in a timely manner and confirm customer understands information.
• Attend assigned open enrollment meetings at customer locations.
• Visit Employer group locations on a set schedule to assist with member questions or concerns.
• Visit Provider offices to update staff on changes or provider questions as necessary.
• Create and write customer service FAQs for distribution.
• Flexible in dealing with customer needs, including deviations of normal practices, procedures, or benefit structures.
• Recognize member as not only a customer but an individual whose health status/preferences are unique.
• Recommend improvements in processing and procedures by informing appropriate personnel of revisions.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
MINIMUM JOB REQUIREMENTS:
• Post high school education or experience.
• Valid Driver’s License and access to a vehicle
• 12 months customer service experience OR 12 months experience in an office environment.
• Data entry and/or typing experience.
• Software Proficiencies: Microsoft Office (Word, Excel, Access, Outlook)
• Interpersonal, verbal, and written communication skills.
• Analytical and organizational skills and independent decision-making skills.
• Ability to spend most of the scheduled time on the phone according to business needs and sit for long periods of time with scheduled breaks.
• Ability to drive to off-site meetings as required.
PREFERRED JOB REQUIREMENTS:
• 18+ months customer service experience.
• Experience working with various lines of health insurance business, including individual, group, self-funding, CDHP, Medicare, Wellness, and Disease Management.
• Knowledge of medical terminology and claims processing
• Proven ability to learn quickly and adapt to change.
• Preference given to those who hold a Health and Accident Insurance license.
FULL TIME BENEFITS OFFERED:
• Competitive Salary commensurate with experience
• Health Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Paid Time Off
To apply, send cover letter, resume, and reference list to [email protected] or
Member/Provider Service Concierge
The Preferred Healthcare System
PO Box 1015
Duncansville, PA 16635
