- Handle all escalations based upon region and ensure proper communication of the resolution within required timeframe agreed upon by the client
- Serve as a liaison between client sales force and applicable party
- Ability to effectively mediate situations in which parties are in disagreement and facilitate a positive outcome
- Concurrently handle multiple outstanding issues and ensure all items are resolved in a timely manner to the satisfaction of all parties
- Responsible for reporting any payer issues by region with the appropriate team
- Log and maintain a reconciliation report for all Field requests to send to client at their designated preferred date range
- Support team with call overflow and intake when needed
- Must self-audit activities to ensure accuracy and efficiency for the program
- As needed conduct research associated with issues regarding the payer, physician’s office, and pharmacy to resolve issues swiftly
- Proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and delivery of product in a timely manner.
Qualifications
- Previous customer service experience, preferred
- High School diploma or equivalent, preferred
- Demonstrated high level customer service
- Experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals, preferred
- Knowledge of Medicare, Medicaid and Commercially insured payer common practices and policies, preferred
- Knowledge of the Health Insurance Market Place and the Affordable Care Act preferred