Loss Prevention Associate at TJ Maxx preventing theft and ensuring store safety. Supports a vibrant team and contributes to a positive customer shopping experience in the store.
About the role
- Customer Service Representative managing inbound patient calls and resolving drug coverage issues. Providing expert assistance to clients and coordinating services for reimbursement in healthcare.
Responsibilities
- Receive & manage 10-60 inbound patient calls per day, depending on time of year
- Facilitate cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization
- Perform medical /pharmacy benefits verification requiring complex decision skills based on payer and process knowledge resulting in onboarding or no starting specialty patients
- Contact benefit providers to gather policy benefits/limitations
- Coordinate and ensure the services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
- Directly interface with external clients
- Provide expert assistance to clients on patient status
- Liaison for the company providing referral status reporting
- May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome
- Handle escalations
- Use discretion & independent judgment in handling more complex client complaints, escalating as appropriate
- Complete other projects and additional duties as assigned
Requirements
- HS Diploma or GED required
- 3+ years' relevant work experience preferred
- Customer service experience required; Healthcare or Pharmacy experience with medical insurance knowledge and terminology and experience in patient access preferred
- Data entry skills and working knowledge of Microsoft Office
- Strong phone presentation and communication skills
- RxHome or Care Central experience a plus
- Demonstrated ability to handle professionally challenging customers
- Ability to adapt in a dynamic work environment and make decisions with minimal supervision
- Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions
- Strong attention to detail & critical thinking skills
Benefits
- Must be able to work Monday - Friday, 9am - 6pm EST
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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