Job Description
Note:
The job is a remote job and is open to candidates in USA. KPH Healthcare Services, Inc. is a multistate organization, and they are seeking a Patient Benefit Specialist responsible for all aspects related to adjudication and billing of specialty prescriptions in a call center environment. The role includes monitoring adjudication queues, facilitating prior authorization processes, and providing customer service support to ensure member satisfaction. Responsibilities 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 Skills Must be available, and on-time for scheduled work shifts Must be able to work nights and weekends as required Minimum: High School Diploma or GED Past experience in a customer service related field 6-12 months experience as a pharmacy technician Drug test Initial and continuous exclusion and sanction/disciplinary monitoring Any and all additional eligibility requirements based on the specific position 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 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 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 Pharmacy technician or related certification Company Overview KPH Healthcare Services, Inc.
It was founded in 1903, and is headquartered in East Syracuse, New York, USA, with a workforce of 1001-5000 employees. Its website is