Patient Benefit Specialist (1386)

Thisiscny; City of Syracuse (NY); On-site; USD 38,000 - 48,000; Full time

Job summary

Thisiscny in Syracuse, NY manages adjudication and billing for specialty prescriptions in a call center setting. The role involves interfacing with members and prescribers, documenting data in TherigySTM, and guiding prior authorizations to resolution.

Candidates should have a high school diploma or GED; pharmacy technician certification is preferred, with prior customer service and call-center experience valued.

Qualifications

• Experience in customer service in a professional setting.
• Pharmacy technician certification or equivalent preferred.
• Familiarity with adjudication and billing concepts is a plus.

Responsibilities

• Monitor adjudication queue(s).
• Contact members and prescribers on non-covered items.
• Facilitate prior authorization processes for customers.
• Document patient information into TherigySTM.
• Provide customer service coverage for incoming calls and direct calls.
• Resolve customer service issues to ensure member satisfaction.
• Assist members with payment related issues on accounts/orders.
• Maintain production levels as directed by supervisor.
• Assist in orienting and training new employees.
• Complete all mandatory and regulatory training programs.
• Perform other duties as assigned.

Skills

Customer service

Call center

Pharmacy terminology

Education

High School Diploma or GED

Pharmacy technician certification

Tools

TherigySTM

Job description

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

Qualifications

Educational Requirements:

• Minimum: High School Diploma or GED
• Preferred: Pharmacy technician or related certification

Experience:

• Past experience in a customer service-related field
• 6-12 months experience as a pharmacy technician preferred