Pharmacy Provider Liaison

Davita Inc.; New York (NY); Remote; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare company seeks a Pharmacy Provider Liaison to facilitate communication between healthcare providers and the corporate health plan. The role entails managing claims issues, coordinating services, and improving performance within healthcare practices, requiring strong healthcare experience and customer service skills.

Qualifications

• High School Diploma required, 3+ years of healthcare experience.
• Preferred: Bachelor's degree, CPhT license.
• Knowledge of Medicare/Medicaid and claims billing preferred.

Responsibilities

• Act as liaison between providers and health plan, resolve claims issues.
• Manage provider calls and ensure seamless member services.
• Conduct outreach to providers and members for service coordination.

Skills

Customer service

Claims billing/coding knowledge

Knowledge of health care

Education

High School Diploma or equivalent

Bachelor's degree in healthcare related field

Certified Pharmacy Technician (CPhT)

Job description

Job Title: Pharmacy Provider Liaison

Location: Remote (Preferred: EST Time Zone)

Duration: 12 Months (Potential to Extend)

Shift:

Monday to Friday

• Between 8 AM & 6 PM EST

Saturday: days on rotation basis -might be involved as the program evolves. Subject to change and have flexibility

Position Purpose

Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider physician injectable claims issues. Perform training, orientation and coaching for performance improvement within physician practices. Communicate effectively and partner with all internal departments to ensure members and providers have a positive, successful outcome.

Duties and Responsibilities

• 
  

  Assist with coordination of healthcare personnel administered drug services at preferred sites of care.

  
  


• 
  

  Provide seamless member and provider services through phone queue management.

  
  


• 
  

  Answer provider calls, retrieve voicemails, and follow up with providers and members.

  
  


• 
  

  Review prior authorizations to confirm appropriate site of care.

  
  


• 
  

  Redirect members to alternative servicing providers based on policy.

  
  


• 
  

  Conduct outreach via phone to providers and members.

  
  


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  Track performance based on quality of service, successful contacts, and site of care review completion.

  
  

Education and Experience Requirements

Required:

• 
  

  High School Diploma or equivalent

  
  


• 
  

  3+ years of experience in healthcare

  
  

Preferred:

• 
  

  Bachelor's degree in healthcare related field

  
  


• 
  

  Certified Pharmacy Technician (CPhT) license

  
  


• 
  

  Knowledge of health care, managed care, Medicare or Medicaid

  
  


• 
  

  Claims billing/coding knowledge

  
  


• 
  

  Customer service experience