Operations Customer Service Quality Consultant
AllMed Healthcare Management’s mission is to improve the quality and integrity of healthcare by providing independent medical review services that help payers and providers deliver better health outcomes. We provide pre-authorization and appeals decision-making services through PeerPoint®, AllMed’s state-of-the-art Medical Review Portal. We partner with over 300 leading US health insurance and hospital organizations and have maintained consistent 20% annual growth, through our commitment to the highest quality, client satisfaction, and technology innovation. We have recently undergone a lean transformation, driving continuous improvement in our performance. As a result, AllMed’s client list includes many of the nation’s top names in healthcare.
We are seeking an experienced customer service professional to join our Operations team as an Operations Customer Service Quality Consultant. This is a full-time opportunity working at our beautiful headquarters office in downtown Portland, Oregon.
Responsible for operational excellence and customer retention through issue resolution, process improvement, and excellent customer service. The Operations Customer Service Quality Consultant is a subject matter expert who handles in-bound and out-bound client communication to resolve non-clinical issues, questions, and other customer service concerns related to AllMed Healthcare Management operations and cases. This role assists with development and maintenance of documentation related to operational processes, business rules, and pre-defined content for inclusion in training and content repositories under the direction of Clinical Operations Leadership. This role may also be delegated training and project management responsibilities related to client implementations and other operational initiatives.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- In collaboration with the Clinical Customer Service Quality Consultant:
- Answers, triages, troubleshoots and responds to non-clinical client concerns related to completed cases (i.e. pullbacks, reconsiderations or other customer service issues/inquiries) and escalates appropriately. This will include communication to the appropriate Client. Services representative and other internal collaboration as needed.
- Assists with resolution of non-clinical issues related to cases prior to completion as requested by Clinical Operations leadership, including andon management.
- Supports Clinical Operations Leadership and Client Services for client calls and meetings as needed.
- Supports Client Services with sales demonstrations and client training/onboarding as needed.
- Assists with project management related to client implementations and operational initiatives when delegated.
- Assists with development and maintenance of documentation related to operational processes, business rules, and pre-defined content for inclusion in the training and content repositories under the direction of Clinical Operations Leadership.
- Manages duties in a timely and efficient manner.
- Utilizes Customer Relationship Management (CRM) system to input, monitor and track reported client complaints or issues.
- Manages and maintains client information repositories (Client Notes) to ensure accurate and timely information for processing of cases as directed.
- Contributes to team effort by accomplishing related results as needed.
- Participating in cross functional teams and Lean continuous improvement activities including root cause identification and problem solving to improve processes;
- Other duties as directed by Clinical Operations leadership.
- Participates in the peer reviewer and operations staff performance feedback systems and utilizes data to identify areas for quality and operational improvement.
- Provide data into performance feedback systems.
- Analyze performance data to provide Clinical Operations and Medical Director leadership with insight to continually improve turn-around-times and quality.
- Builds & maintains positive working relationships with customers through regular phone contact and establishment of personal connections.
- Maintain effective rapport with other staff members, client professional support staff, administrators, and physicians’ offices.
- Actively support corporate strategic plans.
- Maintain confidentiality and privacy as defined by state, federal, and company regulations and policies.
EDUCATION AND EXPERIENCE
- Degree required, 4-year or higher university degree is preferred
- A strong customer service orientation and teamwork ethic are essential
- Knowledge and understanding of the healthcare industry, terminology and standards is preferred, preferably with at least two years’ experience in a healthcare setting
- High energy and the ability to work at a fast pace in a volume-oriented production environment
- Outstanding interpersonal skills, verbal communications, ability to negotiate with peers as well as supervisors
- Ability to provide feedback in a positive yet assertive way
- Very strong organizational skills and ability to re-prioritize quickly
- Ability to make decisions within scope of position and work with minimal supervision
- Computer literacy with demonstrated proficiency in Microsoft Office, email, database and contact management software, and browser-based workflow applications
- Ability to type at least 35 words per minute
- Willingness to ask questions, take initiative to streamline office procedures and practices
- Ability to maintain office security
- Exhibits a high degree of professionalism in written and verbal communications
- Ability to read and comprehend instructions, correspondence, and memos
- Ability to write professional correspondence
- Ability to effectively present information to referring entities and office staff
- Strong listening skills
- Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, etc.
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
- Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
AllMed offers generous compensation and our competitive benefits program includes comprehensive medical and dental care, matching 401K, paid time off, flexible spending accounts, disability coverage, and other benefits that help provide financial protection.
AllMed provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, AllMed complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.