The Pharmacy Customer Service Advocate assists member, providers, and pharmacies with inquiries for member's eligibility, claim status, precertification requirements, and claims coverage questions by phone, fax, email, and US mail, working independently within the scope of their duties. The Customer Service Advocate coordinates the handling of numerous daily, time-sensitive functions required to maintain an efficient workflow and direct all maters to a proper resolution.
Job Responsibilities:
•Maintain HIPAA/PHI guidelines to ensure the confidentiality of all calls and documents
•Interpret plan documents/plan guidelines
•Determine eligibility by reviewing, researching, and analyzing information in the appropriate system
•Use critical thinking and reasoning to manage workload with above average level
•Maintain and enter information into systems as information is received
•Forward all records to the appropriate parties
•Record and respond to calls/emails/faxes from Member, Providers, and Pharmacies
•Maintain high level of knowledge to answer specific Pharmacy Plan Benefit information or sharing guideline related questions
•Review issues as they arise
•Serve as a role model in demonstrating core values of customer service
•Provide timely and thorough responses to internal and external customers
•Escalate difficult issues to the appropriate party
•Provide exceptional customer service for incoming/outgoing calls
•Propose process improvements to enhance customer service satisfaction
•Ensure compliance with service standards
•Develop and execute plans to meet established goals
•Provide continuous feedback to strengthen and optimize quality performance
•Work cross-departmentally to improve or streamline procedures
•Maintain up to date knowledge on industry trends and look for new data sources
•Develop or improve current internal processes to improve overall quality
•Accurate and complete documentation of all daily interactions
•Special projects as assigned
Skills and Abilities:
•Excellent verbal and written communication skills with high attention to detail
•Excellent customer service skills
•Strong analytical and problem-solving skills
•Confident decision-making abilities
Advanced Medical Pricing Solutions (AMPS) provides market leading healthcare cost containment services for self-funded employers, public entities, brokers, TPAs, payers and many other entities. As we continue to grow, we look for driven professionals who share our core values.
We take a "one team" approach to keeping clients satisfied and engaged with our products and services for the long-term.
•Demonstrated ability to work independently, prioritize workloads, multi-task effectively, and manage priorities to meet deadlines
Requirements
Education and Experience:
•High school diploma or equivalent required
•PBM Experience
•Minimum 2 years customer service or claims experience in the Health Insurance Industry
•Preferred experience in Call Center Customer Service
•Preferred experience in Pharmacy Tech
•Must have experience in handling multi-line telecommunication systems and electronic documentation software
•Knowledge of medical/pharmaceutical terminology required
•Health Insurance/Eligibility and Benefit knowledge required
•Prior authorization experience preferred
•Bilingual a plus
Physical Requirements:
•Indoor office environment with moderate noise
•Hybrid position
•First 90 days in office for training
•Intermittent physical effort may include lifting to 25 lbs., walking, stopping, kneeling, crouching or crawling may be required
•Frequent sitting, use of a keyboard, reaching with hands and arms, talking, and hearing approximately 70% of the time; 30% or less time is spent standing
•Normal vision abilities required including close vision and ability to adjust focus
•Travel up to 10% of the time may be required
Salary Description

$44,000 per year