Customer Service Representative managing inbound patient calls and resolving drug coverage issues. Providing expert assistance to clients and coordinating services for reimbursement in healthcare.
Responsibilities
Receive & manage 10-60 inbound patient calls per day, depending on time of year
Facilitate cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization
Perform medical /pharmacy benefits verification requiring complex decision skills based on payer and process knowledge resulting in onboarding or no starting specialty patients
Contact benefit providers to gather policy benefits/limitations
Coordinate and ensure the services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
Directly interface with external clients
Provide expert assistance to clients on patient status
Liaison for the company providing referral status reporting
May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome
Handle escalations
Use discretion & independent judgment in handling more complex client complaints, escalating as appropriate
Complete other projects and additional duties as assigned
Requirements
HS Diploma or GED required
3+ years' relevant work experience preferred
Customer service experience required; Healthcare or Pharmacy experience with medical insurance knowledge and terminology and experience in patient access preferred
Data entry skills and working knowledge of Microsoft Office
Strong phone presentation and communication skills
RxHome or Care Central experience a plus
Demonstrated ability to handle professionally challenging customers
Ability to adapt in a dynamic work environment and make decisions with minimal supervision
Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions
Strong attention to detail & critical thinking skills
Benefits
Must be able to work Monday - Friday, 9am - 6pm EST
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