JOB SUMMARY:

This position is responsible for providing high quality telephone and support services to Kaiser Permanente members, staff and associates via the automated call distribution system or approved telephony system. This position is responsible for ensuring timely and efficient practitioner, hospital, and patient communication support and other support as required. The incumbent will answer telephone calls and schedule appropriate appointments, answer medical records inquiries, following established policies and procedures. The role also follows appropriate processes for connections to the advice nurse for clinical review based on appropriate symptoms list or guidelines. The position answers questions about the members health plan, medical records and forms and supports message management processes. All calls will be conducted in a prompt, professional, concise, courteous, standardized, and accurate manner to assure customer-focused service. The position is also responsible for managing incoming calls to the regional operator line and routing to appropriate department. The incumbent maintains proficiency in navigating the electronic medical record for scheduling and/or information gathering and completing required documentation in all appropriate systems.

BASIC QUALIFICATIONS:

Experience

• Minimum one (1) year experience in a similar customer service position.
• Minimum one (1) year experience in a high volume call center or chat experience.

Education

• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• N/A

ADDITIONAL REQUIREMENTS:

• Working knowledge of PC with keyboarding skills of 35 wpm minimum.
• Ability to communicate effectively and courteously on the telephone.
• Ability to effectively interact and negotiate with diverse work units at all organizational levels.
• Demonstrated analytical and problem-solving skills.
• Complete a Customer Service Assessment.
• Customer service aptitude demonstrated through Customer Service Assessment.
• Knowledge of medical terminology.

PREFERRED QUALIFICATIONS:

• Appointment-setting experience in a clinical setting or health care service role preferred.
• Medical Records experience in a clinical setting responding to inquiries for health information for forms and records preferred.

• Schedules, reschedules, cancels and/or verifies patient appointments utilizing decision tree or appropriate scheduling tool as required.
• Verifies member and benefit eligibility, creates medical record numbers or connects to national call center.
• as required and request membership cards.
• Facilitates communication between parties and routes messages utilizing message management processes, smart-phrases or other tools per established guidelines.
• Refers calls for member hospitalization to the Health Care Team or On-Call provider if after hours.
• Maintains and distributes the After-Hours Call Schedule and core hospital diversion status.
• Utilizes the Referral Consultant List to locate specialists within or outside of Kaiser Permanente.
• Utilizes kp.org and appointment wait list as required.
• Collaborates with Quality Resource Managers (QRM) when inpatient and/or outpatient services are needed.
• Educates members on proper use of Health Plan systems, processes, facilities. and required authorization forms for the release of health care information.
• Follows department processes to support members who need bilingual or hearing-impaired services.
• Collects cumulative data and statistics as needed; may enter data into automated systems.
• Train and orient new or less experienced staff, as needed. Provides peer support as needed.
• Demonstrates, in-depth, operational knowledge of each Health Information Management (HIM) area by analyzing caller needs and evaluating documentation to ensure that requests are routed to the appropriate resource.
• Ensures members requests for forms and medical records are completed within turnaround time goals or expedited when required. When appropriate fulfills releases records with a verbal request following guidelines and protocols.
• Manages calls on the Regional Operator Line. and ensures callers are transferred to the appropriate department.
• Supports secured messaging via designated technology including chat, cell phone, text messaging or other identified tool.
• Responds to and follows-up on messages left on the Regional Operator Line voicemail.
• May participate in special projects, studies, or other activities as directed.