Title: Call Center Representative Health Plan Location: New Mexico, USA Job Description: Full time job requisition id R-5570 Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237 Compensation Pay Range: Minimum Offer $15.99 Maximum Offer $23.76 Now Hiring: Call Center Representative Health Plan Summary: Please note. This role is a work at home role available for New Mexico residents only at this time. Build your Career. Make a Difference. Presbyterian is hiring a skilled Call Center Representative to join our team. Type of Opportunity: Full time Job Exempt: No Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Days (United States of America) Responsibilities: Responsible for providing customer service for members and providers in all PHP benefit plans. Ensure callers receive service excellence when responding to telephone, written, Pres Online, E-Business, chat and in person inquires. Some key responsibilities include - High school diploma plus one to three years office/business experience; call center experience preferred and/or is currently demonstrating customer service skills, meeting current department metric and attendance guidelines within department. - Claims processing experience in managed care with possible enrollment experience is preferred. - Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, physicians, and physician office staff. Written communication skills as well as business writing and presentation skills are required. - Requires strong 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 CRM and Facets, 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. Must be able to prove ability to type 30 wpm with 90% accuracy. Qualifications: - High school/GED diploma - One year office/business experience - Call Center experience preferred. All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more. 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. About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are 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 1600 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.

Support evidence-based stroke care by collaborating with a multidisciplinary team, maintaining patient confidentiality, and ensuring quality practices across multiple hospitals while managing patient care throughout the continuum.

• Contactarnos con clientes de otro operador a que pasen a ser parte del equipo de claro

Title: Care Manager – Patient Support Call Center -Remote Locations: Pocatello, United States of America / Phoenix, United States of America Las Vegas, United States of America Olympia, United States of America Redondo Beach, United States of America Salem, United States of America San Jose, United States of America Vancouver, United States of America R1532044 Job Description: Care Manager - Patient Support Call Center - Remote Philadelphia, United States of America | Full time | Home-based | R1532044 Job available in additional locations Apply Now Share this job This is posted in anticipation of a future role Position Summary: Care Managers are responsible for contacting insurance companies to obtain correct eligibility information, perform benefit investigations, copay assistance, and check prior authorization and/or appeal status. The information contained herein is intended to be an accurate reflection of the duties and responsibilities of the individuals assigned to this position. They are not intended to be an exhaustive list of the skills and abilities required to do the job. IQVIA reserves the right to revise the job or to require that other or different tasks be performed as assigned. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee. Care Manager As the only global provider of commercial solutions, IQVIA understands what it takes to deliver nationally and internationally. Our teams help biopharma get their medicines to the people who need them. We help customers gain insight and access to their markets and ultimately demonstrate their product's value to payers, physicians, and patients. A significant part of our business is acting as the biopharma's sales force to physicians or providing nurses to educate patients or prescribers. With the right experience, you can help deliver medical breakthroughs in the real world. Responsibilities will vary by program and its lifecycle. Care Manager's may be responsible for contacting insurance companies to obtain correct eligibility information, perform benefit investigations, copay assistance, and check prior authorization and/or appeal status. Care Managers may also be responsible for directly contacting patients and/or providers to evaluate eligibility for assistance programs and/or varied adherence support. This is a remote position. Job Responsibilities: • Perform outbound calls to obtain appropriate information and document accurately. • Responsible for answering in-bound calls and assisting customers with pharmacy-related services. • Maintain strict professionalism in all communication methods while providing efficient, courteous, and friendly service. • Contact insurance companies for benefit investigation and coverage eligibility. • Provide prior authorizations and appeals support. • Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs. • Update job knowledge by participating in educational opportunities and training activities. • Work efficiently both individually and within a team to accomplish required tasks. • Maintain and improve quality results by adhering to standards and guidelines by meeting quality standards set forth by program KPI's. • Report ADE's according to program policy and guidelines. • Adhere to all HIPAA guidelines. • May assist with onboarding new employees. Schedule: Must be available for an 8-hour shift between 8am-8pm EST. Required Qualifications: • High School Diploma or equivalent • Minimum one year of experience in medical billing, reimbursement, insurance verification, or similar related medical office experience. • Previous data entry experience (minimum three months) and ability to type 30wpm+. • Able to demonstrate high attention to detail in work. • Must be computer savvy, including navigating multiple computer tabs, monitors, and applications. • Advanced ability/knowledge of all Microsoft Suite programs (Teams, Word, Excel, Outlook, etc.) and soft phone systems (WebEx, Mitel, Shoretel, etc.). • Exceptional communication skills, both written and verbal. • Able to work in a virtual team environment by being available and responsive during working hours. • Excellent follow-through. Preferred Qualifications: • Some College. • Bilingual Spanish - English. • Previous experience in Patient Support Services (Hub). • Previous Customer Service experience in the healthcare field. About IQVIA: IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. https://jobs.iqvia.com/eoe IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism. **The potential base pay range for this role is $22.00 - $24.00 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits. Apply Now