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Customer Service Representative

Posted 9 days ago

Opportunity in Highly Demanded Healthcare Field!

Position: Customer Service Representative
Location: Carbondale, IL 62901
Hourly Rate: $ 18.28/hr.
Term: 6 months

Day-to-Day Responsibilities:

  • Will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of the Client as the client and in accordance with Medicare Part D CMS Regulations.
  • 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.

Is this a good fit? (Requirements);
  • 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
  • High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.