Description: Job Summary:

This position provides high level member assistance by scheduling various appointments requested, transferring calls appropriately, composing messages, and providing general information.

Essential Responsibilities:
Upholds Kaiser Permanentes Policies and Procedures, Principles of Responsibilities and applicable state, federal and local laws.Operates in a high volume, highly structured call center environment by responding to incoming calls.Determines the type of appointment requested or needed, reviews scheduling mix of various physicians/providers, and them makes appointment utilizing appropriate guidelines.Prioritizes member needs and offers alternatives to members when appropriate.Utilizes superior customer service skills to provide service to members when diffusing difficult member encounters.Uses tact and diplomacy in handling difficult interactions with members.Determine if calls are urgent or emergent by listening to the member, following established guidelines, and then transferring the call to a Registered Nurse when appropriate.Composes messages for physician/providers, Registered Nurses or other medical staff based on member requests.Responds in a courteous and professional manner to general questions, using on-line databases to provide information to any member or other personnel calling the center.Identifies ways to improve quality of service to members and recommends steps used to accomplish these changes.Must perform all of the above duties while meeting established standard of performance for quality and productivity.Performs clerical duties which may include assigning new members a primary care physician, processing self-referral requests, calling patients and booking appointment for specialty appointments, calling members to cancel and reschedule appointments.Answer incoming calls.Determine type of appointment needed, determine appointment availability and schedule appointments.Prioritize members need and offer alternatives to member when appropriate.Determine if calls are urgent or emergent and refer to RNs as appropriate following established guidelines.Compose messages to providers or other medical staff based on member requests.Utilize databases to give information to members and other callers as requested.Refer members to eligibility department as appropriate.Notify members of appointment/scheduling changes by telephone as directed.Schedule, reschedule and/or verify appointments.Answer member inquiries.Contact appropriate department to obtain medical record numbers of new enrollees.Assist in resolving problems related to duplicate medical record numbers.Initiate change of physician requests.Initiate change forms for corrected medical record numbers.Verify and update member demographics.Perform on-line inquiry functions.Perform data retrieval of computerized data.Record and maintain activity logs.Clear paper jams and other routine maintenance of printers/copiers.Recommend procedure changes.Train and orient new or less experienced personnel.Serve as resource persons to co-workers and assist in problem solving.Perform other activities and duties as directed.Initiate telephone calls to physicians or other medical office staff when indicated to assist members.Assume other activities and responsibilities from time to time as directed. Basic Qualifications:
Experience

One (1) year of customer service experience in a service related industry, preferably healthcare.
Per the National Agreement, current KP Coalition employees have this experience requirement waived.

Education

High school diploma or equivalent.

License, Certification, Registration

N/A

Additional Requirements:

Effective telephone communication skills and excellent interpersonal skills.
Must obtain passing score on Customer Care Simulation assessment.
The Customer Care Simulation assessment score must be current within one (1) year (contact Local HR Office for testing).
Must be able to effectively communicate, verbally and in writing, in English.
Must complete Service Orientation Assessment.
As part of applicant process, must take Proofreading Assessment for non KP employees only.

Bilingual (English/Spanish) Level I required.

Preferred Qualifications:

N/A.

Notes:

 Must successfully pass or have passed the bilingual test (within the last 12 months), or be active in the QBS program.