Title: Patient Services Representative Location: Anywhere in US (Remote) Duration: 3 month assignment Shift timings: 8:00 AM - 8:00 PM EST
1st shift- 8:00am - 4:30pm
2nd shift- 11:30am - 8pm
Note : candidate should be fine for both shfts. Hours during training: Monday – Friday, 8:30 am-5:30pm EST
Position Summary: Under general direction of an Operations Manager, responsible for providing well defined services to patients, providers, and caregivers. Team members will work interactively with patients and their healthcare providers to complete enrollment activities, answer basic program inquiries, and help coordinate access to therapies through the patient’s healthcare provider.
Primary Duties and Responsibilities:
Depending on the program specific contracted services an associate may perform one or more of the following activities:
Inbound Phone Queue/General Program Inquires
Determination for support programs (Copay, PAP, Medicaid, etc.)
Pharmacy triage and coordination
Order processing for wholesale orders
Other follow-up activities (missing info, prior authorization, etc.)
Intakes and reports adverse events as directed.
Researches and resolves any claim denials or underpayment of claims.
Effectively utilizes various means for collecting information using approved methods, which could include phone, fax, mail, and online methods.
Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
Reports any trends or delays to program management (e.g., billing denials, claim denials, pricing errors, payments, etc.).
Ensures all program correspondence and communication (phone, fax, mail, etc) meets quality standards.
Works with patient, provider and or internal shared services to ensure all necessary documentation is received and complete in accordance with program policy.
Works on problems of moderate scope where analysis of data requires a review of a variety of factors.
Exercises judgment within defined standard operating procedures to determine appropriate action.
Required to be self-motivated, working from a queue (phone or system).
Expected to perform work in accordance with defined standard operating procedures.
Management will monitor queues and provide active feedback as required.
Performs related duties as assigned.
Experience and Educational Requirements:
High school diploma or GED required.
Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, customer service or similar vocations generally obtained through completion of a two-year associate degree program, technical vocational training, or equivalent combination of experience and education.
Three years (3) + years directly related, and progressively responsible experience required.
A two-year degree can be used in lieu of 2 years of the experience requirement or a four-year degree in lieu of the experience requirement.
Minimum Skills, Knowledge, and Ability Requirements:
Ability to communicate effectively both orally and in writing.
Ability to build productive internal/external working relationships.
Strong interpersonal skills.
Strong mathematical skills.
Strong organizational skills and attention to detail.
General knowledge of accounting principles, pharmacy operations, and medical claims.
General knowledge of health care billing preferred.
Ability to proficiently use Microsoft Excel, Outlook, and Word.
Developing professional expertise; applies company policies and procedures to resolve a variety of issues.
Work Environment
The work environment characteristics described here are representative of those an associate encounter while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions: The noise level in the work environment is consistent with an office setting.
Physical and Mental Requirements The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
Visual requirement is for close vision, distance vision, peripheral vision, and ability to adjust focus.
75% or more time is spent looking directly at a computer.
Ability to deal with stressful situations as they arise.
CPRA: The Company is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAhr@spectraforce.com.
About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.
Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation. At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $17.00/hr.
