Note: The job is a remote job and is open to candidates in USA. KPH Healthcare Services, Inc. is a multistate organization focused on healthcare services, and they are seeking a Patient Benefit Specialist to manage the adjudication and billing of specialty prescriptions. The role involves customer service responsibilities in a call center environment, ensuring member satisfaction and resolving payment-related issues.
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
Skills
- 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
- 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
- Pharmacy technician or related certification
- 6-12 months experience as a pharmacy technician
Company Overview
KPH Healthcare Services, Inc. It was founded in 1903, and is headquartered in East Syracuse, New York, USA, with a workforce of 1001-5000 employees. Its website is https://www.kphhealthcareservices.com/en/.