Presbyterian Healthcare Services

Receive alerts when this company posts new jobs.

APPEALS & GRIEVANCE SPECIALIST-FLUENT - CENTENNIAL 2.0

at Presbyterian Healthcare Services

Posted: 12/10/2018
Job Status: Full Time
Job Reference #: 17480
Keywords:

Job Description

About Us

Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of eight hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.

 

Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.

 

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.

 

Job Description 

Type of Opportunity: Full Time

FTE: 1.000000

Exempt: No

Work Schedule: Days

Location: Rev Hugh Cooper Admin Center

 

Education:
Essential:
* High School Diploma or GED


Requirements:
High School education or G.E.D. equivalent required. Associates Degree preferred. Three years experience in a customer service setting required of which one year in a health care environment is preferred. Experience in managed care field such as Claims or Member Services strongly preferred. Experience with healthcare databases is preferred

 

Competencies and skills:
Nonessential:
* 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
* SKILL-Ability to effectively interact with customers to understand their needs and explain data
* SKILL-Microsoft Office
* Planning and coordinating organizational change \n
* Adapting and responding to a Changing Circumstance \n
* Building Customer confidence by increasing satisfaction, achieving expectations, and ensuring commitments are met\n
* Demonstrating integrity and ethics in day-to-day tasks and decision making\n
* Educating Employees, Customers & Transferring Knowledge\n
* Managing and Resolving Problems\n
* Functioning as an Effective Contingent Member\n
* Coordination of diverse organizational needs\n
* SKILL-Written communication

 

Summary:
Responsible for responding to verbal and written complaints, grievances, and requests for appeals that involve complex matters. Responsible for performing comprehensive research to clarify facts and circumstances. Able to identify the root cause for an issue. Assure that customers and health plan providers receive exceptional service when acknowledging, discussing, documenting or responding to their issue of dissatisfaction. Makes initial decision regarding resolution of complaints, grievances or appeals based on completed research. Responsible for making sure issues are categorized and can be reported to internal stakeholders, oversight committees and regulatory agencies. Able to act as a member advocate in each case, comparing the grievant/appellants issues with the organization s documented facts

 

Benefits

Benefits are effective day-one (for .45 FTE and above) and include:

  • Competitive salaries<\>

  • Full medical, dental and vision insurance<\>

  • Flexible spending accounts (FSAs)<\>

  • Free wellness programs<\>

  • Paid time off (PTO)<\>

  • Retirement plans, including matching employer contributions<\>

  • Continuing education and career development opportunities<\>

  • Life insurance and short/long term disability programs<\><\>

     

    About New Mexico

    New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich life>Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.

     

    Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.

     

    New Mexico offers endless recreational opportunities to explore, and enjoy an active life>

     

    AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!