CALL CENTER TERMINOLOGIES
ACW?
AFTER-CALL WORK; THE TIME IMMEDIATELY AFTER A CALL AGENTS USE TO COMPLETE SUPPLEMENTARY WORK IN RELATION TO THE CALL
WHAT ARE SOME BARRIERS TO COMMUNICATION? 2 EXAMPLES
LANGUAGE, NOISE, TIME, DISTRACTIONS, CULTURE
GIVE 2 EXAMPLES OF THE TOP 10 FOR PERFECT CALL HANDLING
GREETING, ACTIVE LISTENING, CARE & EMPATHY, PARAPHRASING, ASSURANCE & COMMITMENT, SETTING EXPECTATIONS, POSITIVE LANGUAGE, PROBING, OWNERSHIP & RESOLUTION, AND ADVOCACY
ADMISSION VS DISCHARGE?
ADMISSION IS THE BEGIN DATE OF ENTRY INTO A FACILITY FOR TREATMENT WHILE DISCHARGE IS THE TIME YOU LEAVE TO RETURN HOME
WHO ARE THE 3 P's
PATIENT, PROVIDER, PAYER
FCR?
FIRST CALL RESOLUTION; BEING ABLE TO RESOLVE A MEMBER'S ISSUE ON THE FIRST CALL
?????
FREEBIE
WHAT ARE THE 3 RIGHTS OF AN AGENT?
ATTITUDE, SKILLS, KNOWLEDGE
ALLOWED AMOUNT?
THE AMOUNT ALLOWED BY THE INSURANCE FOR A PARTICULAR SERVICE ACCORDING TO A CONTRACTED/NEGOTIATED RATE WITH THE PROVIDERS
GIVE ONE SIMILARITY BETWEEN MEDICARE AND MEDICAID
SERVICES PEOPLE WITH DISABILITIES, PRESCRIPTION DRUG COVERAGE, INPATIENT AND OUTPATIENT HOSPITAL CARE
HOW LONG IS ASA?
7 SECONDS
SYMPATHY?
SHOWING PITY FOR A PERSON'S MISFORTUNES
WHAT IS THE MOST IMPORTANT RIGHT OF AN AGENT?
ATTITUDE
CALENDAR YEAR VS PLAN YEAR; EXAMPLE
JAN 1, 2023 - DEC 31, 2023 (CALENDAR YEAR) AND FEB 12, 2023 - FEB 11, 2024 (PLAN YEAR)
WHAT ARE THE 4 CLASSES OF PAYERS?
GOVERNMENT SPONSORED, COMMERCIAL, WORKERS' COMPENSATION, AND NO FAULT LIABILITY
WHAT IS ATTRITION?
TERM USED TO COVER LOSS OF STAFF- DESCRIBED AS A PERCENTAGE OF THE TOTAL STAFF
?????
FREEBIE
HOW LONG IS DEAD AIR ALLOWED FOR
LESS THAN 1 MINUTE
PRE-EXISTING CONDITION
A PHYSICAL OR MENTAL IMPAIRMENT THAT EXISTED BEFORE GETTING THE INSURANCE PLAN
WHAT ARE ROUTINE SERVICES AND GIVE AN EXAMPLE
SERVICES PERFORMED TO ENSURE A PERSON STAYS HEALTHY AND PREVENTS ILLNESS; CLEANING OR X-RAYS
WHAT IS KPI AND GIVE AN EXAMPLE
KEY PERFORMANCE INDICATOR - PERFORMANCE AREAS CRITICAL FOR SUCCESS OF THE ORGANIZATION
QUALITY SCORE, AHT, FCR, VOC
EMPATHY?
THE ABILITY TO UNDERSTAND AND SHARE FEELINGS WITH ANOTHER
HOW DO YOU PROPERLY PLACE A MEMBER ON HOLD?
ALWAYS ASK FOR THEIR PERMISSION, STATES THE LENGTH OF THE HOLD AND SHOW APPRECIATION
CAPITATION?
THE AMOUNT THE INSURANCE WILL PAY THE PROVIDERS FOR EACH PATIENT EACH MONTH
WHAT IS THE CYCLE OF HEALTHCARE REIMBIRSEMENT?
1. PATIENT DOES THE SERVICE W THE PROVIDER
2. PROVIDER RECORDS SERVICES AND FILES CLAIMS
3. CLAIMS ARE SENT TO INSURANCE TO BE REVIEWED
4. INSURANCE WILL PAY THE PROVIDERS FOR THE SERVICES DONE