Note: candidate should be fine for both shift timmings.
Job Details:
Complete data entry from the enrollment form into the CRM.
Complete electronic eligibility checks for payer and coverage details.
Conduct a benefit investigation to determine plan coverage, payer restrictions, and cost share information from insurance plans.
Identify if coverage restrictions exist, the process in which they are handled.
Collect PA requirements, follow up with the insurance for prior authorization status, and communicate the results to the healthcare provider.
Conduct follow up outreach to healthcare providers to collect information needed to evaluate for services.
Evaluate patient records against eligibility criteria to determine if they can continue free drug assistance.
Position Summary: Under the general supervision of an Operations Manager, the Customer Access Specialist will be providing advanced services to patients, providers, and caregivers on behalf of patients for a specific manufacturer sponsored program or set of programs.
Primary Duties and Responsibilities:
Provides advanced services to patients, providers, and caregivers. Services could include but not limited:
Billing and coding support.
Claims assistance, tracking and submission.
Prior authorization assistance and tracking.
Coordination of benefits.
Benefit verification result call.
Welcome calls.
Advanced alternate coverage research.
Appeals/Denials.
Intakes and reports adverse events as directed.
Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
Establishes themselves as regional experts regarding payer trends and reports any reimbursement trends/delays to management team (e.g. billing denials, claim denials, pricing errors, payments, etc.).
Processes any necessary correspondence.
Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA).
Maintains confidentiality in regard to all patient sensitive information.
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, could include well defined services generally performed by other program representatives (e.g., benefit verifications, PAP determinations).
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. Four years (4) + years directly related and progressively responsible experience required. A two-year degree can be used in lieu of 2 years of the experience requirement, a four-year degree in lieu of 4 years of experience.
Minimum Skills, Knowledge and Ability Requirements:
Ability to communicate effectively both orally and in writing.
Ability to build productive internal/external working relationships.
Advanced interpersonal skills.
Strong mathematical skills.
Basic analytical skills.
Advanced organizational skills and attention to detail.
General knowledge of accounting principles, pharmacy operations, and medical claims.
Acceptable use of medical industry vernacular.
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.
