Prospect Medical Systems

Call Center Representative

Prospect Medical Systems

United States
Aug 3rd, 2022
$ / Hour
Award-winning, personalized care for our members – with a strong emphasis on prevention and wellness – to help them live healthier lives.

Comprehensive, expert support services designed to help relieve the administrative burden on our providers and allow them to focus on what they do best – care for our members.

Prospect Medical Systems is uniquely able to provide quality care and service to the people who matter most to us – our members and our providers.

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. In the months and years ahead, we will be offering our services in other states and other markets throughout the nation. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services.

Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. Our pledge to members is that we will give you exceptional care delivered by compassionate physicians who have a strong commitment to each and every patient. Our physicians work closely with teams of skilled nurses and other healthcare professionals.

Prospect Medical contracts with most major health plans, and we serve all product lines, including Commercial, Medicare, Medicaid, Medicare/Medicaid (Medi-Medi) and Health Insurance Exchange.

To further improve the health of the communities we serve, Prospect Medical offers comprehensive health education classes and support services through our numerous outreach programs.
Orange
https://prospectmedicalsystems.com/

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

This position is responsible for answering telephone calls in a prompt, courteous, professional manner and acting as a liaison between Prospect Medical/ProMed Healthcare and: members; contracted and non-contracted care providers, ancillary providers; health plans; billing companies; collection companies, to provide assistance and respond to service requests. Representative is responsible for being a resource for other team members.
Job Responsibilities/Duties

  • Assist customers on the telephone with inquiries, updates, changes related but not limited to claims, eligibility, referrals, PCP changes, billing, access, transportation and general coordination of care through thorough research in a timely manner. The monthly expectation is to perform at a quality level of 90% accuracy of all measures. The daily expectation is to efficiently answer a minimum of 60 calls per day (inbound).
  • 100% thorough documentation of every call.
  • Thoroughly verify HIPAA requirements to ensure account accuracy.
  • Follow-up on all open issues.
  • Communicate recurring issues and trends to management.
  • All other duties assigned.

Qualifications
Minimum Education: High school diploma or equivalent.

Minimum Experience: A minimum of two (2) years of customer service experience in a call center environment required. Within a health care setting preferred. Ability to multi-task, prioritize, and work in a fast pace environment. Ability to multi-task, prioritize, and work in a fast pace environment. Knowledge of HIPAA regulations preferred. Knowledge of IPA operations in a health care setting preferred. Knowledge and experience of claims , eligibility, and referrals preferred. Must be proficient in Microsoft Office navigation, Excel, and Word and/or IDX knowledge.

Req. Certification/Licensure: None.
Employee Value Proposition
Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Job Type: Full-time

Pay: From $20.00 per hour

Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Schedule:

  • 8 hour shift

COVID-19 considerations:
This position is now a fully remote, WFH role. Because of the industry and regulations, candidates are required to be vaccinated or get vaccinated.

Experience:

  • Customer service: 2 years (Preferred)
  • Call center: 2 years (Required)

Work Location: Remote

If you require alternative methods of application or screening, you must approach Prospect Medical Systems directly to request this, as we're not responsible for the employer's application process.

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