Patient Benefit Specialist Jobs

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.

Job Duties

• Provide clinical services in TherigySTM
• Responsible for completing all mandatory and regulatory training programs
• Facilitate prior authorization process for customers
• Responsible for contacting members and prescribers on non-covered items
• May assist in orienting and training new employees
• Work with members to provide resolution to payment related issues on accounts/orders
• Provides resolution to customer service issues to ensure member satisfaction
• Perform other duties as assigned
• Maintain and keep reasonable production as determined by supervisor
• Responsible for monitoring adjudication queue(s)
• Customer service coverage for incoming calls and directing incoming calls

Attendance Requirements

• Must be able to work nights and weekends as required.
• Must be available, and on-time for scheduled work shifts.

Educational Requirements

• Preferred Pharmacy technician or related certification
• Minimum High School Diploma or GED

Experience

• Past experience in a customer service related field
• 6-12 months experience as a pharmacy technician

Special Conditions of Employment

• Drug test
• Any and all additional eligibility requirements based on the specific position
• 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
• Outstanding customer service skills
• Excellent organization skills
• Strong communication skills
• Successful completion of a pre-employment and/or random drug screening test
• Excellent computer and keyboarding skills
• Ability to multitask and prioritize

Required Training

• MethGuard CE Mastery Exam
• Fraud, Waste, and Abuse Course
• MethGuard Course
• HIPPA Security CE Mastery Exam
• Fraud, Waste, and Abuse CE Mastery Exam
• HIPPA Privacy Course
• HIPPA Privacy CE Mastery Exam
• HIPPA Security Course

Behavioral Traits Required

• Leadership Must gain acceptance of ideas and accomplish goals through subordinates, peers and teams
• 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
• Cooperation Must work harmoniously and effectively with fellow employees, supervisors and others you are in contact with
• Involvement Must enjoy the demands of the job and work with interest and enthusiasm
• 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