Under the general supervision of an Operations Manager, the Customer Access Specialist will be providing advanced services to patients, providers, and caregivers on behalf of patients for a specific manufacturer sponsored program or set of programs.
PRIMARY DUTIES AND RESPONSIBILITIES:
1. Provides advanced services to patients, providers and caregivers. Services could include but not limited to:
a. Billing and coding support
b. Claims assistance, tracking and submission c. Prior authorization assistance and tracking d. Coordination of benefits e. Benefit verification result call f. Welcome calls g. Advanced alternate coverage research h. Appeals/Denials i. Intakes and reports adverse events as directed.
2. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
3. Establishes themselves as regional experts regarding payer trends and reports any reimbursement trends/delays to management team (e.g. billing denials, claim denials, pricing errors, payments, etc.).
4. Processes any necessary correspondence.
5. Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA).
6. Maintains confidentiality in regards to all patient sensitive information.
7. Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
8. Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with defined standard operating procedures. Management will monitor queues and provide active feedback as required.
9. Performs related duties as assigned, could include well defined services generally performed by other program representatives (e.g. benefit verifications, PAP determinations).
EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
High school diploma or GED required. Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate’s degree program, technical vocational training, or equivalent combination of experience and education. Four years (4) + years directly related and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement, a four-year degree in lieu of 4 years of experience.
MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
1. Ability to communicate effectively both orally and in writing.
2. Ability to build productive internal/external working relationships.
3. Advanced interpersonal skills.
4. Strong mathematical skills.
5. Basic analytical skills.
6. Advanced organizational skills and attention to detail.
7. General knowledge of accounting principles, pharmacy operations, and medical claims.
8. Acceptable use of medical industry vernacular.
9. General knowledge of health care billing preferred.
10. Ability to proficiently use Microsoft Excel, Outlook and Word.
11. Developing professional expertise; applies company policies and procedures to resolve a variety of issues.
MMC, is an Equal Opportunity Employer, M/F/D/V. Please feel free to contact us if you are an individual with a disability and require accommodation in the application process.
MMC Group LP
Why Work Here?MMC makes finding and applying for jobs simple. Partner with MMC to find the right opportunities across multiple industries in the US. Find out more by visiting www.MMCGRP.com MMC, is an Equal Opportunity Employer, M/F/D/V. Please feel free to contact us if you are an individual with a disability and require accommodation in the application process.
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