Under general direction of an Operations Manager, responsible for providing well defined services to patients, providers and caregivers. Team members will work interactively with patients and their healthcare providers to complete enrollment activities, answer basic program inquiries, and help coordinate access to therapies through the patient’s healthcare provider.
PRIMARY DUTIES AND RESPONSIBILITIES:
1. Depending on the program specific contracted services an associate may perform one or more of the following activities:
a. Inbound Phone Queue/General Program Inquires b. Determination for support programs (Copay, PAP, Medicaid, etc.) c. Pharmacy triage and coordination d. Order processing for wholesale orders e. Other follow-up activities (missing info, prior authorization, etc.) f. Intakes and reports adverse events as directed.
2. Researches and resolves any claim denials or underpayment of claims.
3. Effectively utilizes various means for collecting information using approved methods, which could include phone, fax, mail, and online methods.
4. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
5. Reports any trends or delays to program management (e.g. billing denials, claim denials, pricing errors, payments, etc.).
6. Ensures all program correspondence and communication (phone, fax, mail, etc) meets quality standards.
7. Works with patient, provider and or internal shared services to ensure all necessary documentation is received and complete in accordance with program policy.
8. 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.
9. 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.
10. Performs related duties as assigned.
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. Three years (3) + years directly related and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement or a four-year degree in lieu of the experience requirement.
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. Strong interpersonal skills.
4. Strong mathematical skills.
5. Strong organizational skills and attention to detail.
6. General knowledge of accounting principles, pharmacy operations, and medical claims.
7. General knowledge of health care billing preferred.
8. Ability to proficiently use Microsoft Excel, Outlook and Word.
9. Developing professional expertise; applies company policies and procedures to resolve a variety of issues.
The work environment characteristics described here are representative of those an associate encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is consistent with an office setting.
PHYSICAL AND MENTAL REQUIREMENTS:
The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
1. Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling, repetitive motions, talking and hearing.
2. Visual requirement is for close vision, distance vision, peripheral vision and ability to adjust focus.
3. 75% or more time is spent looking directly at a computer.
4. Ability to deal with stressful situations as they arise
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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