Job Description

Scope of Responsibilities: Works under general supervision. Follows standard procedures to accomplish assigned tasks. May assist in orienting and training employees

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 per 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