Location: Espanola,NM, USA
Summary:Coordinate and administer services for patients seeking emergent care within the Emergency Department in situations where other avenues of care are more appropriate to effect optimal patient outcomes, achieve continuity and quality of care and reduce costs
Type of Opportunity: Full Time FTE: 1.000000 Exempt: No Work Schedule: Days
Other information:High school diploma plus one to three years call center experience and/or claims processing experience preferably in managed care with possible enrollment experience.
Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff using strong dialogue and customer service competencies.
Written communication skills as well as business writing and presentation skills are required.
Requires strong consulting, counseling, and conflict management skills for effective patient and family member advocacy. Organizational skills, ability to create, sort and analyze reports (Excel, Access, etc) and system processes.
A thorough knowledge of reimbursement methodologies i.e. DRG, Relative Value Systems, Per Diem, Fee schedule, Capitation, etc and some knowledge of risk sharing programs helpful. Some knowledge of Facets, Epic, Medipac, Zoll as well as any other databases that may be used PHS Enterprise wide. Demonstrated ability to function effectively as a team member.
Requires ability to retain plan details and basic medical terminology. Must be able to work cooperatively with other employees and function under pressure. Demonstrated ability to sustain quality standards. Ability to type 30 wpm with 90% accuracy
Education:Essential:* High School Diploma or GED
Responsibilities:*Creates collaborative relationships with patients and clinical staff across a variety of areas within Presbyterian and external to the organization to ensure patients receive quality healthcare services. *Provides consulting and educational services with patients to reach collaborative agreements regarding appropriate venues of care in alignment with instructions from the ED staff. *Administers PCP assignments for Health Plan Members and schedules appointments with physicians as instructed by designated clinical staff in the Emergency Department.*Practices respecting and valuing the differences in each person and demonstrates an inclusive style that fosters dialogue for collaborative solutions in recommending resources for financial assistance and with the administration of presumptive Medicaid enrollment.*Demonstrates a firm understanding of Presbyterian s array of health plan benefits and services to educate members regarding their respective benefit plans, resulting in enhanced customer satisfaction, knowledge, and loyalty with Presbyterian Health Services.*Plans time, priorities and resources to effectively coordinate travel for patients to alternative venues of care to achieve goals for sustainable results that contribute to the organization s strategy*Performs other functions as required.
We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!
Learn more about our employee benefits:
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.
Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.
About Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
About Our Regional Delivery System
Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico continues to grow steadily in population and features a low cost-of living.
Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.
New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
USD $23.07The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.