Patient Benefit Specialist

KPH HEALTHCARE SERVICES, INC; City of Syracuse (NY); On-site; USD 40,000 - 56,000; Full time

Job summary

KPH Healthcare Services, Inc. is seeking a specialist to manage adjudication and billing for specialty prescriptions within a busy call center.

Responsibilities include monitoring adjudication queues, contacting members and prescribers on non-covered items, and facilitating prior authorizations.

You will document patient information in TherigySTM, provide resolution to service issues, and participate in required training and duties. Maintain production levels and assist in onboarding new staff.

Responsibilities

• Monitoring adjudication queues
• Contacting members and prescribers on non-covered items
• Facilitating prior authorization processes for customers
• Documenting patient information into TherigySTM
• Providing customer service coverage for incoming calls
• Resolving customer service issues to ensure member satisfaction
• Working with members to resolve payment-related issues on accounts/orders
• Maintaining production levels as directed by supervisor
• Assisting in orienting and training new employees
• Completing mandatory and regulatory training programs
• Performing other duties as assigned

Job description

Job Summary Responsible for all aspects related to adjudication and billing of specialty prescriptions in a call center environment.

Job Summary Responsible for all aspects related to adjudication and billing of specialty prescriptions in a call center environment.

Job Duties

• Responsible for monitoring adjudication queue(s)
• Responsible for contacting members and prescribers on non-covered items
• Facilitate prior authorization process for customers
• Document patient reported information into 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