Overview

Scope of Responsibilities: Works under general supervision. Follows standard procedures to accomplish assigned tasks. May assist in orienting and training employees

Job Summary: Responsible for all aspects related to adjudication and billing of specialty prescriptions in a call center environment.

Responsibilities

Job Duties:

• Responsible for monitoring adjudication queue(s)

• Responsible for contacting members and prescribers on non-covered items

• Facilitate prior authorization process for customers

• Provide clinical services in TherigySTM

• Customer service coverage for incoming calls and directing incoming calls

• Provides resolution to customer service issues to ensure member satisfaction

• Work with members to provide resolution to payment related issues on accounts/orders

• Maintain and keep reasonable production as determined by supervisor

• May assist in orienting and training new employees

• Responsible for completing all mandatory and regulatory training programs

• Perform other duties as assigned

Qualifications

Attendance Requirements:

• Must be available, and on-time for scheduled work shifts.

• Must be able to work nights and weekends as required.

Educational Requirements:

• Minimum: High School Diploma or GED

• Preferred: Pharmacy technician or related certification

Experience:

• Past experience in a customer service related field

• 6-12 months experience as a pharmacy technician

Special Conditions of Employment:

• Drug test

• Initial and continuous exclusion and sanction/disciplinary monitoring

• Any and all additional eligibility requirements based on the specific position

Job Skill Requirements:

• Broad knowledge of medications, physician orders, and pharmacy systems

• Familiar with Enterprise billing options and practices surrounding claim submission

• Strong communication skills

• Outstanding customer service skills

• Excellent organization skills

• Ability to multitask and prioritize

• Excellent computer and keyboarding skills

• Successful completion of a pre-employment and/or random drug screening test

Required Training:

• HIPPA Privacy Course

• HIPPA Security Course

• Fraud, Waste, and Abuse Course

• MethGuard Course

• HIPPA Privacy CE Mastery Exam

• HIPPA Security CE Mastery Exam

• Fraud, Waste, and Abuse CE Mastery Exam

• MethGuard CE Mastery Exam

Behavioral Traits Required:

• Cooperation: Must work harmoniously and effectively with fellow employees, supervisors and others you are in contact with

• Initiative: Must work within supervision guidelines and assume additional responsibilities

• Flexibility: Must be willing to work variable work schedules, nights and weekends, assist others as requested and available, and be willing to perform all assigned work

• Adaptability: Must respond to new situations in a positive way, accept change, support new ideas, master new routines and grasp explanations, apply current knowledge in new environments and experiences

• Involvement: Must enjoy the demands of the job and work with interest and enthusiasm

• Customer Service: Must provide superior customer service (for Noble customers, fellow employees and business partners), listen attentively to their needs and respond appropriately

• Safety: Must take care of equipment and employ good safety habits

• Leadership: Must gain acceptance of ideas and accomplish goals through subordinates, peers and teams

Compensation

$17.50-19.37 per hour.

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience,and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state , and federal regulations as it pertains to minimum wage requirements .

Connect With Us! (https://kphcareers-kphhealthcareservices.icims.com/jobs/13192/patient-benefit-specialist--remote/job?mode=apply&apply=yes&in_iframe=1&hashed=-336031866)

Job Locations US-NY-Syracuse

Posted Date 2 months ago (9/16/2024 4:24 PM)

Requisition ID 2024-13192

# of Openings 2

Category Customer Service/Support

Location : Location US-NY-Syracuse