101 Mall Boulevard Monroeville, PA 15146
- The primary responsibilities are to verify insurance coverage for potential new patients and re-verify insurance coverage for existing patients in order to process patient prescription needs successfully and demonstrate excellent customer service to patients, healthcare professionals and insurance carriers.
- Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests in accordance with Medicare Part D CMS Regulations.
- Must apply information [provided through multiple channels to the plan criteria defined through work instruction.
- Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
- Responsible for research and correction of any issues found in the overall process.
- Phone assistance is required to initiate and/or resolve coverage requests.
- Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed.
- Must maintain compliance at all times with CMS and department standards.
- Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
- Customer service focus. Basic experience in MSWord and MSExcel.
- Familiar with medical terminology and knowledge of medical coding.
- Ability to read and interpret billing documents.
- The position also requires an extensive amount of data entry work.
- 2 years experience.
- Strong Attention to detail
- Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality
- Proficient computer skills and the ability to navigate in a Windows based environment
- Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible
- Ability to work in a high pressure, time sensitive environment
- Project a professional business image, through phone interaction as well as internal communications
- Demonstrated problem-solving ability and attention to detail
- Demonstrated sense of urgency with assignments
- Strong organizational skills
- Strong telephone skills
- Ability to read and understand pharmacy/medical terminology
- Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations.
- Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations.
- Ability to perform basic mathematic calculations maybe required
- Ability to interpret a variety of work instructions provided through a variety of mediums
- Ability to anticipate needs and resolve issues with urgency
- Ability to consistently meet quality and production standards
- Displays confidence in the ability to learn complex material
- Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results
- Education: High School Diploma or GED required.
- Associates degree in Business,
- Accounting or equivalent work experience preferred.