Customer Service

This is the primary service-level position in a business to business multimedia PBM contact center. The Member Services Rep serves as an initial point of contact to clients, nurses, pharmacies and physicians for inbound and outbound calls, faxes, e-mails, files and orders. The MSR also handles multimedia contacts from nurses authorizing payment for medications for hospice patients which must be entered into a web-based database within required turnaround times. Accuracy and knowledge of various operating procedures for different customers is a must. Additionally, customer service receives multimedia contacts from retail and long term care pharmacies requiring claims processing assistance, reimbursement disputes, and contract requests. Representatives must review all claim data and authorizations on file to resolve rejection issues.
Excellent customer service skills are a must in all interactions with hospice clients and pharmacy partners.
Qualifications - External
• Serve as initial point of contact to all incoming patient profiling, medication updates by pharmacies, nurses and other healthcare provider.
• Utilize multi-media functions (phone calls, faxes, and e-mail and integration files) to accurately input patient profile eligibility, medical history, clinical data, and updates into company operation platforms.
• Assist pharmacies in claims processing by providing information needed to process claims and researches all information related to pharmacy rejections.
• Process medication overrides for dosage changes or RTS (refills too soon), etc.
• Input manual claim data into the database on claims outside of processing window.
• Input appropriate claim processing call tracking notes with each call received.
• Provide patient medication profiles to facility pharmacies.
• Troubleshoot and resolve pharmacy related issues for Client Services.
• Input appropriate call-tracking notes with each call, fax, e-mail, or integration received.
• Transfer HospiOnDemand clients to clinical pharmacists for consults and create work order tickets and consult notes for pharmacist request.
• Assign coverage, transfers patients, or trouble shoots rejections as directed by clinical pharmacists.
• Work all assigned discharges and censuses from the Discharge Data Base.
• Implement new clients into the system for startup and quality check for accuracy and completeness.
• Accurately complete special projects assigned by management.
• Exhibit compliant and ethical behavior in the performance of job responsibilities, including complying with all applicable federal and state laws and regulations, company Code of Conduct, Business Ethics Policies and Procedures and other policies and procedures applicable to position.
• Actively participate in Compliance and Ethics Program, including attending annual compliance and ethics training and reporting suspected violations of the law or Catamaran’s policies and procedures.
• Follow all policies and procedures relating to job responsibilities.
• Perform any and all other duties and tasks as assigned by management to meet corporate objectives.
• Meet or exceed departmental performance standards and Provides world class customer service.
Knowledge, Skills, and Abilities (including Core Competencies)
• Knowledge of proper telephone etiquette; previous call center experience preferred.
• Must have attention to detail with excellent problem solving and multi-tasking skills
• Computer literacy / data entry skills are required and proficiency in Microsoft Word, Outlook, and Excel
• Excellent written and verbal communication skills are required.
• Experience with image display software and web-based data entry software.
• Knowledge of Medical Terminology and ICD-10 Codes preferred.
• Knowledge of drug therapies. (Generic/Brand names, drug classes, sigs)
• Basic math and analytical skills.
• Possess a positive attitude and strong work ethic.
• Ability to work in a team environment and promote teamwork.
• Need to be able to work a flexible schedule including nights and weekends.
Education and Experience
• Previous pharmacy technician experience highly desired, certification or licensure highly desired and/or related PBM business experience with knowledge of long term care pharmacy billing.
• Must have a High School diploma or equivalent. College or technical training a plus.



Training is 3 weeks from 8am05pm after training
Shift Start/End Time: Start times between 8:00am - 10:00am / End Times between 5:00pm - 7:00pm

Dress Code: Business Casual

  • Apply with Adecco

Reference number US_EN_99_025068_359733