The Pharmacy Customer Service Representative serves as an initial point of contact to clients, nurses, pharmacies and physicians for inbound and outbound calls, faxes, e-mails, files and orders. The Pharmacy Customer Service Representative also handles multimedia contacts from nurses authorizing payment for medications for hospice patients which must be entered into a web-based database within required turnaround times. This is the primary service-level position in a business to business (B2B) multimedia pharmacy benefit management (PBM) contact center. Accuracy and knowledge of various operating procedures for different customers is a must.
Additionally, customer service receives multimedia contacts from retail and long term care pharmacies requiring claims processing assistance, reimbursement disputes, and contract requests. Representatives must review all claim data and authorizations on file to resolve rejection issues.
Excellent customer service skills are a must in all interactions with hospice clients and pharmacy partners.
Responsibilities:
- Serve as initial point of contact to all incoming patient profiling, medication updates by pharmacies, nurses and other healthcare providers. Utilize multi-media functions (phone calls, faxes, and e-mail and integration files) to accurately input patient profile eligibility, medical history, clinical data, and updates into company operation platforms.
- Assist pharmacies in claims processing by providing information needed to process claims and researches all information related to pharmacy rejections.
- Process medication overrides for dosage changes or RTS (refills too soon), etc.
- Input manual claim data into the database on claims outside of processing window.
- Input appropriate claim processing call tracking notes with each call received.
- Provide patient medication profiles to facility pharmacies.
- Troubleshoot and resolve pharmacy related issues for Client Services.
- Input appropriate call-tracking notes with each call, fax, e-mail, or integration received.
- Transfer HospiOnDemand clients to clinical pharmacists for consults and create KACE tickets and consult notes for pharmacy request.
- Assigns coverage, transfers patients, or trouble shoots rejections by direction of the clinical pharmacists for HOD (HospiOnDemand) clients.
- Work all assigned discharges and censuses from the Discharge Data Base.
- Implement new clients into the system for startup and quality check for accuracy and completeness.
- Accurately complete special projects assigned by management.
- Exhibit compliant and ethical behavior in the performance of job responsibilities, including complying with all applicable federal and state laws and regulations, Catamaran’s Code of Conduct, Business Ethics Policies and Procedures and other policies and procedures applicable to position.
- Actively participate in Catamaran’s Compliance and Ethics Program, including attending annual compliance and ethics training and reporting suspected violations of the law or Catamaran’s policies and procedures.
- Follow all policies and procedures relating to job responsibilities.
- Perform any and all other duties and tasks as assigned by management to meet corporate objectives.
- Meet or exceed departmental performance standards and Provides world class customer service.
Education and Experience :
- Must have a High School diploma or equivalent. Undergraduate degree preferred
- Previous pharmacy technician experience highly desired, certification or licensure highly desired and/or related PBM business experience with knowledge of long term care pharmacy billing.
Knowledge, Skills, and Abilities (including Core Competencies):
- Knowledge of proper telephone etiquette; previous call center experience preferred.
- Must have attention to detail with excellent problem solving and multi-tasking skills
- Computer literacy / data entry skills are required and proficiency in Microsoft Word, Outlook, and Excel
- Excellent written and verbal communication skills are required.
- Experience with image display software and web-based data entry software.
- Knowledge of Medical Terminology and ICD-10 Codes.
- Knowledge of drug therapies. (generic/brand names, drug classes, sigs)
- Basic math and analytical skills.
- Possess a positive attitude and strong work ethic.
- Ability to work in a team environment and promote teamwork.
- Need to be able to work a flexible schedule including nights and weekends.
Job Type: Full-time
Salary: $11.00 /hour
Required experience:
- Customer service in medical office, pharmacy or related environment: 1 year
Required education:
- High school or equivalent
» Apply Now
Please review all application instructions before applying to Catamaran.
|
EmoticonEmoticon