Job Description
ESSENTIALS ROLES AND RESPONSIBILITIES
1. Answer incoming pharmacy calls regarding issues related to a claim transaction, reimbursement, payment, and other required information in accordance with PharmPix Pharmacy Help Desk Call Center performance metrics.
2. Answer incoming providers’ and beneficiaries’ calls following Call Center scripts, in a timely matter and in accordance with PharmPix call center performance metrics.
3. Answer incoming calls and perform outbound calls according to HIPAA and Pharmacy Laws Standards.
4. Identify pharmacies, providers and beneficiaries needs, clarify information, research every issue and providing solutions.
6. Route the case to the corresponding internal department or the appropriate Health Insurance Carrier.
7. Guide pharmacies, providers and beneficiaries regarding the process of claim
transmission, reimbursement and payment.
9. Evaluate on an individual basis to determine if the patient meets the criteria for a coverage determination for alerts such as DURs (Drug Utilization Reviews), HMO (Health Maintenance Organization) among other rejections evaluations required by business.
10. Identify system issues and route to the corresponding internal department.
11. Make outbound calls to pharmacies, providers and beneficiaries if necessary.
12. Support all Quality Management Program initiatives.
TRAINING & EDUCATION
LICENSURE / CERTIFICATION
PROFESSIONAL EXPERIENCE
REQUIREMENTS
The person must have:
EEO Employer Minorities/Females/Disable/Veterans