KPH Healthcare Services

  • Patient Benefit Specialist

    Job Locations US-NY-Syracuse
    Posted Date 2 weeks ago(2 weeks ago)
    Requisition ID
    2018-1329
    # of Openings
    1
    Category
    Customer Service/Support
  • 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:



    • Criminal background check and/or drug test

    • Initial and continuous exclusion and sanction/disciplinary monitoring


     


    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

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