CareConnect Customer Service — Professional Operations Guide

Contents

1 CareConnect Customer Service — Professional Operations Guide

Overview and Contact Model

CareConnect customer service is structured as an omnichannel clinical and non-clinical support function that balances patient empathy with operational efficiency. Typical deployment covers phone, secure chat, email, SMS, and a patient portal; many mature programs also include asynchronous messaging through EHR integrations. For a reference implementation, a center running 24/7 coverage will plan for peak-hour redundancy and disaster recovery to maintain a minimum 99.5% availability for telephone and web channels.

Example contact details for training and documentation purposes: CareConnect Support (example) • Phone: 1-800-555-2273 (example) • Escalations: [email protected] • Website: https://careconnect.example.com (example) • Headquarters: 123 CareConnect Way, Suite 200, Springfield, IL 62704 (example). Publishing these clearly in IVR prompts, appointment emails, and the patient portal reduces repeat contacts by up to 12% in 12–18 months when combined with self-service improvements.

Service Levels, KPIs, and Benchmarks

Defining measurable SLAs upfront ensures predictable patient experience and cost control. Core KPIs should be tracked in real time and on a rolling 28-day window to smooth daily volatility. Targets below reflect industry-leading expectations for a mature healthcare contact center serving mixed primary care and specialty lines.

Average Speed to Answer (ASA): target 20 seconds or less; acceptable range 20–60 seconds for specialty lines.

First Contact Resolution (FCR): target ≥75% for scheduling and billing; 60–70% for complex clinical triage.

Customer Satisfaction (CSAT): target 4.5/5 (or 90% satisfied); measure via 2-question post-contact survey within 24 hours.

Net Promoter Score (NPS): target +40 to +60 in outpatient markets; use quarterly measurement.

Occupancy and Shrinkage: occupancy 75–85% with shrinkage (training/meetings/breaks) planned at 25–30%.

Average Handle Time (AHT): 4–7 minutes for routine calls; 10–18 minutes for clinical triage.

Monitoring these KPIs alongside cost metrics such as cost per contact (target $3–$10 per contact depending on channel and geography) gives a clear picture of performance and profitability. Set automated alerts when any KPI diverges by more than 10% from baseline; escalate to a one-hour management review for critical patient-impact deviations.

Staffing, Training, and Quality Assurance

Right-sizing staff requires Erlang-C modeling for expected arrival patterns. Example staffing guideline: for 1,000 inbound calls/day with peak concurrency of 60 calls/hour, plan for 18–22 full-time agents accounting for shrinkage. For blended teams (phone + chat + email), use a contact-equivalent workload conversion: 1 chat = 0.6 phone call; 1 email = 0.4 phone call. Budget onboarding at 80–120 hours per new agent over the first 90 days, including 24–40 hours of product/EHR training and 8–12 hours of soft-skills and empathy coaching.

Quality assurance should use a mixed-method approach: 100% monitoring for compliance-critical interactions (consent, payments), and statistical sampling (10–20% of interactions) for quality coaching. Establish a quality rubric with 12–18 scored elements (accuracy, communication, escalation adherence, documentation). Typical QA target scores: >85% for new hires within 90 days, >92% for tenured staff. Plan budgetary line items: training materials and LMS licensing $600–$1,500 per agent/year; external clinical QA audits $10,000–$25,000 annually for medium-sized operations.

Technology, Security, and Integration

CareConnect’s stack should include a cloud contact center (Genesys, Twilio Flex, Amazon Connect), a CRM/ticketing system (Zendesk, Salesforce Health Cloud), secure patient messaging, and EHR integration (Epic, Cerner). Typical per-seat licensing ranges: $30–$120/month for cloud telephony, $40–$150/month for CRM per user. Factor in implementation costs: $50,000–$200,000 for a regional rollout with custom EHR adapters and automation workflows.

Security and compliance are non-negotiable. Enforce HIPAA-compliant logging, encryption at rest and in transit (TLS 1.2+), role-based access control, and regular penetration testing (annual). SLA expectations should be explicit with vendors: 99.9% uptime for core telephony and CRM, 24×7 P1 support with 1-hour response and 4-hour remediation targets. Use tokenization for payment processing and configure audit trails to support any post-incident reviews within 48 hours.

Complaint Handling, Escalation, and Refund Policies

Design a clear escalation matrix so agents know ownership at each stage. Publish escalation steps in the agent desktop and require that any complaint involving potential harm or regulatory concern reaches a supervisor within 30 minutes. Refunds and billing adjustments should have delegated authority with thresholds: agents can approve up to $50, team leads up to $500, and managers beyond $500 with documentation.

Escalation Matrix (example): Tier 1 Agent — initial response within 30 minutes; Tier 2 Team Lead — acknowledge within 2 hours and provide action plan within 24 hours; Tier 3 Manager/Clinical Director — review and resolution within 72 hours for non-urgent matters, 24 hours for patient safety incidents.

Documentation: create a single-source complaint record with timestamps, resolution owner, remediation steps, and patient outreach log; retain records for minimum 7 years per typical healthcare retention requirements.

Complaint resolution should be outcome-focused and measurable. Track time-to-resolution, percentage of escalations that convert to policy changes, and repeat-contact rate post-resolution. A best-practice target: resolve 80% of escalated issues within the stated SLA and reduce repeat contacts for the same issue by 30% year-over-year through root-cause fixes.

Measuring Success and Continuous Improvement

Adopt a quarterly business review cadence that maps operational KPIs to business outcomes: appointment no-show reduction, revenue recovery from billing corrections, and patient retention. For example, improving FCR by 5 percentage points often correlates with a 2–4% reduction in churn and measurable decreases in cost-per-contact over 12 months.

Invest in continuous improvement: weekly huddles for frontline feedback, monthly deep-dives on top 3 call drivers, and a formal improvement backlog with ROI scoring. Track initiatives (automation, knowledge-base articles, policy changes) and require each to show projected impact (e.g., reduce calls by 8% or shorten AHT by 1.5 minutes) and actual measured impact within 90 days of deployment.