Customer Service Representative I

MedImpact Healthcare Systems; Tempe (AZ); Sur place; USD 23 000 - 35 000; Plein temps

Résumé du poste

MedImpact Healthcare Systems, Inc. is seeking a detail-oriented Customer Service role to handle phone inquiries from pharmacies, physicians, and members.

You will resolve questions about benefits, claims adjudication, eligibility, and prior authorization, working under general supervision as part of a two-level career path with progression opportunities. The position emphasizes delivering excellent customer service, utilizing multiple systems, and educating customers on policy guidelines while

Qualifications

• Pharmacy Technician Certification required.
• Excellent communication and problem-solving skills.
• Experience handling benefit information and claims adjudication is a plus.

Responsabilités

• Respond to pharmacy, physician, and member inquiries by phone.
• Resolve benefit, eligibility, prior authorization, and claims questions.
• Uphold service standards and document interactions in the CRM.
• Educate customers on PA guidelines and plan rules.

Connaissances

Customer service

Phone support

PBM processes

Claims adjudication

Formation

Pharmacy Technician Certified

Outils

SalesForce.com

MedAccess

Description du poste

Exemption Status: United States of America (Non-Exempt)

$16.47 - $20.80 - $25.13

"Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate."

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact?

Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Summary

Provides outstanding customer service to pharmacies, physicians, health plan sponsors, and their members, beneficiaries, or employees by responding to and resolving phone inquiries related to benefit information, claims adjudication, eligibility verification, prior authorization, and other PBM processes. Works under general supervision, relying upon instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform the functions of the job. The extent of supervision ranges from close to moderate based upon demonstrated skill and performance levels as defined for the position. This position is part of a two-level career path with progression opportunities described in the Core Service Career Path/Succession Planning Guidelines

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Convey a positive image of the company by promptly responding to customer phone inquiries and determining the appropriate actions to resolve issues, gather and provide information, and offer assistance.
• Deliver service that meets or exceeds department performance standards for Average Hold Time, Abandonment Rate, Talk Time, Quality, Adherence, and One-touch Resolution.
• Utilize multiple company database programs to research and resolve complex issues relating to benefit information, claims adjudication, eligibility verification, prior authorization, and other PBM processes. Use task route function, SalesForce.com, and other processes and tools applicable to elevate issues, request follow-up action, or obtain assistance from other areas of the organization as necessary.
• Educate external customers about MedImpact's roles and responsibilities. Provide information about override guidelines, benefit plan restrictions, prior authorization requirements, grievance and appeal processes, and other PBM functions as specified by health plan sponsors in online CS Notes.
• Follow up appropriately with callers to ensure customer satisfaction and timely response to requests. Diffuse irate or emotionally upset customers by appropriately listening to issues, calming the customer, and providing positive solutions to resolve concerns.
• Represent MedImpact in a positive manner by adhering to processes and established procedures and guidelines. Support the department strategy by delivering Customer Service Excellence through telephone courtesy, prompt response to callers, anticipation of customer needs and concerns, solution-oriented problem solving, and adherence to call center scripts, greetings, and call closing messages.
• Identify opportunities and make recommendations to department leadership for improvement of workflow processes, operating systems, training programs, reference materials, and quality initiatives that enhance customer experience.
• Keep current on new plan information and instructions by attending and participating in staff meetings, company-required training programs, and other activities that develop skills, build teamwork, and provide updated information.
• Pharmacy Technician Certified CSR's support physician calls and can review Prior Authorization (PA) guidelines noted in the MedAccess system.
• Be available to answer calls during periods of high volume.
• Serve as a resource to the Customer Service team.

Supervisory Responsibilities

No supervisory responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abil