What are the responsibilities and job description for the Clinical Services Representative position at Script Care LTD?
PURPOSE OF THE ROLE
The Clinical Services Representative will provide clinical and administrative support to the operations of the Clinical department. This position will function to perform various duties and work collaboratively with the Clinical department and with other SCL personnel. Additionally, they will assist with responsibilities that support the operations of the Clinical department in the absence of the Director of Clinical Services. This position will report directly to the Clinical Services Supervisor.
KEY TASK AND RESPONSIBILITIES
- Assist and support the working of episodes in Clinical Work Queue, with limited scope and unable to deny any certifications
- Set up Member Prior Authorizations for max dollar overrides, certifications, and non-certifications
- Run test claims on all Member Prior Authorizations
- Track and trend Member Prior Authorizations upon release of Formulary updates
- Work with customer service to problem solve on the adjustment of current Member Prior Authorization that will not process
- Assist with physician follow up calls
- Run and print non-certification letter report for pharmacist review
- Mail non-certification letters to patients
- Assist with maintaining the Maximum Allowable Cost list
- Track and trend Maximum Allowable Cost inquiries
- Serve as a back-up to assist with responsibilities in the absence of the Clinical Services Coordinator
- Assist and support ad hoc requests as deemed pertinent, as to not conflict with current roles and responsibilities
QUALIFICATIONS
- Bachelor’s Degree preferred
- Certified Pharmacy Technician in good standing with applicable State Board of Pharmacy
- Maintain education and certifications as required by applicable State Board of Pharmacy
- Experience in Pharmacy Benefit Management, specialty case management, or specialty pharmacy preferred
PROFESSIONAL SKILLS, EXPERIENCES AND COMPETENCIES
- Excellent written and verbal communication skills, both internally and externally
- Able to support multiple tasks, initiatives and projects simultaneously with an explicit attention to detail
- Possess strong interpersonal skills and able to work collaboratively across departments
- Strong organization skills, able to manage multiple priorities and deadlines
- Proficiency in Microsoft Office suite and industry related software
