Customer Service Representative - Hybrid - 131587
San Diego, California
Employer: University of California San Diego
Industry:
Salary: $28.51 - $40.85 per hour
Job type: Full-Time
Payroll Title:
BLANK AST 3 Department:
PHSO - MSO Hiring Pay Scale
$28.51 - $40.85 / Hour Worksite:
Greenwich Drive Appointment Type:
Career Appointment Percent:
100% Union:
CX Contract Total Openings:
2 Work Schedule:
Days, 8 hour shifts, Monday - Friday
#131587 Customer Service Representative - Hybrid
Filing Deadline: Wed 8/21/2024
Apply Now
UC San Diego values equity, diversity, and inclusion. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.
This is an internal posting open only to employees within the UC San Diego Health - PHSO-MSO department.
This position will work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive and remote.
DESCRIPTION
Under supervision, the Customer Service Representative is responsible for acting as a liaison between patients, providers, insurance companies, and other areas of Managed Care in regards to complaints, appeals, claims inquires and problems of patients and/or providers. Receives and handles all telephone calls and correspondence pertaining to Customer Service and Claims. Utilizes knowledge of current healthcare administration policies and regulations, including; plan benefits interpretation, utilization process, access methods, enrollment criteria and guidelines, billing, claims policies, compliance, grievance and/or appeal procedures.
Serves as a primary point of contact for the Organization's dedicated ACO/Internal Employee customer service phone line. Records and follows up on patient and/or provider complaints, appeals and some claim inquires. Supports and collaborates with team members and other areas of Managed Care to effectively service all patient and provider inquires.
Additionally, the Customer Service Representative will be responsible for enrollment process including setting up and maintaining member data, processing enrollments, corrections retroactivity adjustments and terminations in EPIC system. May be required to assist Network Management eligibility with monthly reconciliation reports.
MINIMUM QUALIFICATIONS
Annual Full Pay Range: $40,700 - $85,295 (will be prorated if the appointment percentage is less than 100%)
Hourly Equivalent: $19.49 - $40.85
Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).
Apply Now
If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.
If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community .
UC San Diego is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.
For the University of California's Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20
For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination
UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.
UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.
BLANK AST 3 Department:
PHSO - MSO Hiring Pay Scale
$28.51 - $40.85 / Hour Worksite:
Greenwich Drive Appointment Type:
Career Appointment Percent:
100% Union:
CX Contract Total Openings:
2 Work Schedule:
Days, 8 hour shifts, Monday - Friday
#131587 Customer Service Representative - Hybrid
Filing Deadline: Wed 8/21/2024
Apply Now
UC San Diego values equity, diversity, and inclusion. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.
This is an internal posting open only to employees within the UC San Diego Health - PHSO-MSO department.
This position will work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive and remote.
DESCRIPTION
Under supervision, the Customer Service Representative is responsible for acting as a liaison between patients, providers, insurance companies, and other areas of Managed Care in regards to complaints, appeals, claims inquires and problems of patients and/or providers. Receives and handles all telephone calls and correspondence pertaining to Customer Service and Claims. Utilizes knowledge of current healthcare administration policies and regulations, including; plan benefits interpretation, utilization process, access methods, enrollment criteria and guidelines, billing, claims policies, compliance, grievance and/or appeal procedures.
Serves as a primary point of contact for the Organization's dedicated ACO/Internal Employee customer service phone line. Records and follows up on patient and/or provider complaints, appeals and some claim inquires. Supports and collaborates with team members and other areas of Managed Care to effectively service all patient and provider inquires.
Additionally, the Customer Service Representative will be responsible for enrollment process including setting up and maintaining member data, processing enrollments, corrections retroactivity adjustments and terminations in EPIC system. May be required to assist Network Management eligibility with monthly reconciliation reports.
MINIMUM QUALIFICATIONS
- Three (3) years of related experience.
- Previous Managed Care and Customer Service experience.
- Must be proficient in computer skills to create documents in Word, Excel and other standard Microsoft applications.
- Experience/knowledge in entering enrollment updates and membership accurately and in a timely manner.
- Proven ability to interpret plan benefits, utilization policies, enrollments, billings, claims, complaint, grievance and appeals procedures.
- Healthcare environment experience.
- Knowledge of EPIC and health plans.
- Bilingual.
- Must be able to work various hours and locations based on business needs.
- Employment is subject to a criminal background check and pre-employment physical.
Annual Full Pay Range: $40,700 - $85,295 (will be prorated if the appointment percentage is less than 100%)
Hourly Equivalent: $19.49 - $40.85
Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).
Apply Now
If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.
If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community .
UC San Diego is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.
For the University of California's Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20
For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination
UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.
UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.
Created: 2024-08-22
Reference: 28405935
Country: United States
State: California
City: San Diego
ZIP: 92109
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