About the role
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.
Originally posted on Himalayas