Position Summary
Responsible for providing service to providers, pharmacies and patients in accordance with Company standards and contract obligations.
Essential Functions
Critical features of this position are listed below and may be revised, updated or reassigned at management’s discretion in accordance with business needs or other factors.
- Prepares and processes a high volume of requests for authorization of service received through fax, phone and online portals. This process includes completing tasks within the Authorization
- Tracking System (ATS) such as verifying eligibility/benefits and documenting information required to process an authorization such as services/prescriptions requested, provider notes and medical history. These authorization requests are generally forwarded to Care Management for review and approval. Follow‐up activities, including outreach to the provider to obtain missing information, may be required depending on case specifics.
- Enters service outcome information supplied by providers into ATS.
- Performs outgoing telephone contact with providers, provider office staff, pharmacies and patients. Interacts with external customers in a professional and effective manner using telephone scripts, information from ATS and general experience to complete tasks and resolves issues.
- Receives a high volume of inbound calls from providers, provider office staff, pharmacies and patients. Interacts with external customers in a professional and effective manner using telephone scripts, information from ATS and general experience to complete tasks and resolves issues.
- Maintains and uses a current working knowledge of company policies, procedures, systems, contractual obligations, infertility, business and related terminology, and phone system protocol to provide superior service to clients.
- Utilizes the call escalation process appropriately and as directed.
- Prepares prescription requests and forwards approved prescriptions to pharmacy for processing.
- Records and appropriately communicates problems, and suggests improvement to systems, scripts, processes and reports.
- Follows HIPAA protocol when discussing or accessing protected health information.
- Performs other duties as assigned.
Supervisory Responsibilities
No supervisory responsibilities.
Minimum Qualifications
- Minimum of High School graduate or equivalent.
- At least 2 years Customer Service experience in a Call Center environment or 2 years Medical Office experience required.
- Experience using MS Office product including Word and Excel.
Knowledge, Skills, and Abilities
- Medical terminology, CPT, and ICD‐10 coding experience extremely desirable.
- HIPAA experience useful.
- Prior Customer Service experience in the healthcare or health insurance industry desirable.