Job Description
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.
Remote
About the Company:
KPH Healthcare Services
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