Throughout the past 30 years plus, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries.

We have built our reputation on partnering with our clients and candidates to achieve the desired results. Our recruiting professionals have extensive experience matching the right candidate, to the right client, for the right position.

We provide the best opportunities to the most talented candidates in a multitude of industries. MMC is a privately owned business with corporate headquarters in Irving, Texas.

With 2,000 employees, working in 40 states, MMC is able to support all United States locations, and some international locations.

We appreciate your interest in reviewing this particular position and we encourage you to visit our website where you can always search and apply for opportunities at MMC strives to ensure all job posting confirm details of the position, the rate of pay, and acknowledge medical benefits are offered.

Get started on your career journey today! Apply to become a part of the MMC Team! We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

PRIMARY DUTIES AND RESPONSIBILITIES : -Master of all standard and advanced services and willing to perform them as needed for the good of our patients.

Including but not limited to : -Billing and coding support -Claims assistance, tracking and submission -Prior authorization assistance and tracking -Coordination of benefits -Benefit verification result call -Welcome calls -Advanced alternate coverage research -Appeals / Denials -Inbound Phone Queue / General Program Inquires -Determination for support programs (Copay, PAP, Medicaid, etc.

Pharmacy triage and coordination -Order processing for wholesale orders -Other follow-up activities (missing info, prior authorization, etc.

Intakes and reports adverse events as directed. -Non-Clinical adherence services -Engages with manufacturer representatives around items like payer profiles, reimbursement trends, issues with specific offices etc.

Responsible for coordination of services with field reimbursement teams and sales representatives.-Provides exceptional customer service to internal and external customers;

resolves any customer requests in a timely and accurate manner; escalates complaints accordingly. -Independently analyzes, reports, resolves, and communicates any reimbursement trends / delays (, billing denials, claim denials, pricing errors, payments, etc.

Processes any necessary correspondence. -Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA).

• Provides training and support to internal associates. -Fields questions from program representatives and specialists. -Handles initial customer escalations.
• Verifies transactions and processes comply with organizational and departmental policies and procedures; suggests changes and solutions as appropriate.
• Independently and effectively resolves complex accounts with minimal supervision. -Maintains confidentiality regarding all patient sensitive information.
• Works on complex issues where analysis of situations or data requires in-depth evaluation of variable factors. Exercises judgment in selecting methods, techniques, and evaluation criteria for obtaining results.

Networks with key contacts outside own area of expertise. -Acts independently to determine methods and procedures on new or special assignments.

Performs related duties and special projects as assigned. EXPERIENCE AND EDUCATIONAL REQUIREMENTS : High school diploma or GED required.

Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate degree program, technical vocational training, or equivalent combination of experience and education.

Five years (5) years directly related, and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement, a four-year degree in lieu of 4 years of experience.

Four-year degree preferred. MINIMUM SKILLS, KNOWLEDGE, AND ABILITY REQUIREMENTS : -Ability to communicate effectively both orally and in writing.

• Ability to build productive internal / external working relationships. -Advanced interpersonal skills. -Strong mathematical skills.
• Basic analytical skills. -Advanced organizational skills and attention to detail. -Extensive knowledge of pharmacy operations and medical claims.
• Excellent use of medical industry vernacular. -General knowledge of health care billing required. Advanced knowledge preferred.
• Advanced use of Microsoft Excel, Outlook, and Word. -Developing professional expertise; applying company policies and procedures to resolve a variety of issues.

WORK ENVIRONMENT : The work environment characteristics described here are representative of those an associate encounter while performing the essential functions of this job.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions : The noise level in the work environment is consistent with an office setting.

PHYSICAL AND MENTAL REQUIREMENTS : The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions : 1. Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling, repetitive motions, talking and hearing.

2. Visual requirement is for close vision, distance vision, peripheral vision, and ability to adjust focus.3. 75% or more time is spent looking directly at a computer.

Last updated : 2024-05-09