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 an 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.