Position Title: Client Services Specialist I- Med D PBM Technician Rep 1
Position Number: 369649
Location: Work at Home 99999
Position Type: Temporary
Required Skill Set:
Billing, Communications, Customer Service, Microsoft Excel, Microsoft Word, WebEx
**Only U.S. Citizens and those authorized to work in the U.S. can be considered as W2 candidates.**
Anticipated Start Date: 07/19/2021
Anticipated End Date: 11/15/2021
Title: Client Services Specialist I- Med D PBM Technician Rep 1
Location: Working Offsite from Caremark Location anywhere in US, Please note: Actual location may vary, RI, USA, 02895
• Pharmacy Appeals Representative I.
In this role, you will be Responsible for:
• Utilizing multiple software systems to complete Medicare appeals case reviews.
• Meeting or exceeding government mandated timelines.
• Complying with turnaround time, productivity and quality standards.
• Conveying resolution to beneficiary or provider via direct communication and professional correspondence.
• Acquiring and maintaining basic knowledge of relevant and changing Med D guidance.
• Accountable and results driven.
• Critical thinker/problem solver.
• Receptive to constructive feedback and flexible in adapting to change.
• Ability to effectively plan, prioritize, and organize time and workload.
• Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment.
• Proficient in navigation of multiple computer applications.
• Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors.
• Ability to type more than 30 WPM.
• At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service.
• Six months of PBM/pharmaceutical related work strongly desired.
• Opportunity for full-time employment contingent on performance.
• Virtual interviews with supervisors over Webex or phone.
• Hours of operation 8-8 est M-F with rotating weekend.
• Customer service focus.
• Basic experience in MSWord and MS Excel.
• Familiar with medical terminology and knowledge of medical coding.
• Ability to read and interpret billing documents.
• The position also requires an extensive amount of data entry work.
• 2 years’ experience.
• Strong Attention to detail.
• Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality.
• Proficient computer skills and the ability to navigate in a Windows based environment.
• Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible.
• Ability to work in a high pressure, time sensitive environment.
• Project a professional business image, through phone interaction as well as internal communications.
• Demonstrated problem-solving ability and attention to detail.
• Demonstrated sense of urgency with assignments.
• Strong organizational skills.
• Strong telephone skills.
• Ability to read and understand pharmacy/medical terminology.
• Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations.
• Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations.
• Ability to perform basic mathematic calculations maybe required.
• Ability to interpret a variety of work instructions provided through a variety of mediums.
• Ability to anticipate needs and resolve issues with urgency.
• Ability to consistently meet quality and production standards.
• Displays confidence in the ability to learn complex material.
• Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results.
• Must apply information [provided through multiple channels] to the plan criteria defined through work instruction.
• Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
• Responsible for research and correction of any issues found in the overall process.
• Phone assistance is required to initiate and/or resolve coverage requests.
• Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed.
• Must maintain compliance at all times with CMS and department standards.
• Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
• High School Diploma or GED required.
• Associates degree in Business, Accounting or equivalent work experience preferred.
• Bachelor’s degree in related field or equivalent work experience preferred.