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KPH HEALTHCARE SERVICES, INC · 7 hours ago

Patient Benefit Specialist- Remote

United States

Full-time

Remote

New Grad, Entry Level

$17.50/hr - $19.37/hr

0+ years exp

KPH Healthcare Services, Inc. is a multistate organization, and they are seeking a Patient Benefit Specialist responsible for all aspects related to adjudication and billing of specialty prescriptions in a call center environment. The role includes monitoring adjudication queues, facilitating prior authorization processes, and providing customer service support to ensure member satisfaction.

Health CareMedicalPharmaceutical

Responsibilities

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

Qualification

Pharmacy technician certificationMedicationsEnterprise billing practicesCustomer service experienceComputer skillsMultitaskCommunication skillsOrganization skillsLeadershipFlexibility

Required

Must be available, and on-time for scheduled work shifts

Must be able to work nights and weekends as required

Minimum: High School Diploma or GED

Past experience in a customer service related field

6-12 months experience as a pharmacy technician

Drug test

Initial and continuous exclusion and sanction/disciplinary monitoring

Any and all additional eligibility requirements based on the specific position

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

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

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