Customer Care Specialist

Job Summary:

Under the general supervision of the Reimbursement Supervisor, the Customer Care Specialist is responsible for various reimbursement and call center functions, including but not limited to manufacturer services (“HUB”) intake process, pharmacy clearance, accurate and timely claim submission, collection activity, payment posting, and/or refunds, inbound and outbound calls. The below is intended to describe the general content of and requirements for the performance of this job and is not to be construed as an exhaustive statement of essential functions, responsibilities, or requirements.

Primary Duties and Responsibilities

1.Handle inbound/outbound reimbursement calls.

2.Responsible for accurate entry of all inbound faxes such as but not limited to new referrals, refill prescriptions, reimbursement documents, and HUB documentation within a timely manner.

3.Ensure confidentiality of all patient accounts by following HIPAA guidelines and adhering to all company HIPAA policies and procedures and completing all company required HIPAA training in a timely manner.

4.Knowledgeable of and trained to document adverse events as they are reported.

5.Responsible for verifying benefits and coverage information for each patient’s prescription.

6.Responsible for the accurate delivery/communication of insurance benefits to specialty pharmacy patients.

7.Responsible for obtaining prior authorizations and appeals for patients’ prescription.

8.Process specialty pharmacy claims accurately and timely.

9.Post specialty pharmacy cash receipts.

10.Serve as a backup to the Revenue Cycle Management Associate including but not limited to collection activities, claims processing, rejection solution, and phone coverage.

11.Must know acceptable reimbursement ranges for each AnovoRx drug and be able to convert reimbursement rates expressed in WAC and pre-settlement AWP to post-settlement AWP equivalency.

12.Must know and be able to apply the Company’s policy of restrictions on and acceptable waiver of co-payments and provision of reduced price or free goods.

13. Adhere to the drug manufacturers business rules during the patient onboarding process and provide any manufacturer assistance available to the patients as needed.

14.Regular and reliable attendance expected.

15.Other work-related duties as assigned by supervisor/manager.

Minimum Knowledge, Abilities, and Skills Required

1.Must have a high school diploma or equivalent.

2.At least one year experience in reimbursement/insurance.

3.Must be highly motivated, people friendly, organized and detail oriented.

4.Must have excellent computer skills; proficient in Microsoft Office Suite, primarily Word, Excel and PowerPoint.

5.Must have history evidencing reliability and consistency in timeliness, attendance, and quality of work.

6.Must present yourself professionally on the phone and in person.

7.Must articulate thoughts well and communicate them clearly, both verbally and in writing.